Official Newsletter of New Hampshire Nurses Association Quarterly publication direct mailed to approximately 17,000 Registered Nurses, LPNs, and LNAs in New Hampshire.

www.NHNurses.org

April 2018 | Vol. 42 No. 2

Please be sure to notify us with address School Nurses changes/corrections. We have a very large list to keep updated. If the nurse listed no longer lives at this address–please notify us to Under Attack discontinue delivery. Thank You!

There are approximately 500 school nurses in New place. Paula McKinnon, a school nurse for 23 years Please call (603) 225-3783 or email Hampshire, serving 618 public and private schools. The in Salem, stated that Board of Education certification to [email protected] with role of the professional school nurse is currently defined will “validate that school nurses are a vital part of the by New Hampshire School Nurse Certification Law. educational setting.” Nancy Wells, former Department Nursing News in the subject line. Certification ensures a professional level of qualification of Education school nurse coordinator noted “It is for the position of school nurse, which supports a unreasonable to withdraw a process that has been minimal standard of care for students with acute and examined and implemented by a variety of stakeholders Index chronic health needs. All that’s currently required to well-versed in the knowledge and skills our students be a school nurse is to have a nursing license from the deserve, particularly since there hasn’t been enough time state Board of Nursing, but HB 1193, passed in 2016 and to assess its value after implementation for only a few Exeter Hospital Hosts Magnet Appraisers...... 2 signed into law by Gov. Maggie Hassan, changed that. months.” The demands on school nurses have changed The 2016 signed legislation requires a Bachelor’s degree, over the years, and the complexity demands proper President’s Message ...... 3 a minimum of three years of pediatric experience and credentials, she said: “This is not your father’s school From the Ed's Desk...... 3 certification by the Board of Education. Like teachers, nursing.” Certified school nurses have the additional they will have to be recertified every three years by the education necessary for their involvement as a member NHNA Shares a Breakfast with NH Legislators. . . . 4 Department of Education, at a cost of $130 to $150, in of the educational team in planning for students with In My Opinion ...... 5 addition to what they pay for their nursing licenses. special education needs. Existing school nurses were grandfathered when the School of Nursing News...... 6 2016 legislation took effect. Nurses on the Move...... 7 “This is not your father’s school nursing.” Tougher rules for school nurses hired after July 1, 2016, Legislative Update...... 8-9 were supposed to take effect with the start of the school Teaching Back...... 10 year, but a legislative committee that presides over Barbara Ward, Beth Corcoran and Barbara French, all rules and regulations decided in October to give nurses retired school nurses penned a letter to the editor of Kudos...... 10 affected by the new requirements another six years the New Hampshire Union Leader. They noted that one In Honor Of...... 11 to comply. Education Commissioner Frank Edelblut, concern cited is the unavailability of “qualified RNs.” opposed the new rules at the time of their passage and There is an exception available for RNs who do not meet From the Bookshelf Internet...... 12 predicted legislation would be introduced in 2017 to full requirement for certification when hired. Up to six Board of Nursing News...... 13 overturn them. The Bill to overturn the rules bill (HB years is offered for the professional growth necessary 1217) was introduced by Republicans in the NH House. to become fully certified. This is not uncommon, as In Memory of Our Colleagues...... 14-15 certification available in other nursing specialties may Opponents of the new rules say they are unnecessary also be acquired over a period of years. All educational NCLEX Reconsidered...... 16 and make it even more difficult for school districts to staff have to meet certification standards required for When Compassionate Care Takes a Turn hire nurses in a highly competitive market for nursing their specialty and can apply for provisional certification talent. It all adds up to unnecessary regulation and cost, while working toward this goal. Toward Fatigue...... 17 according to Rep. Greg Smith, R-Northwood, sponsor of When the Thrill is Gone ...... 18 the bill. “No case for urgency has been made,” he said Ed Note: When NHNN went to press, the bill was still of the new rules. “There is no danger to the public or in the Education Committee of the House after a public Welcome New and Returning NHNA Members! . . . . 19 school children; no evidence of legal issues that have hearing. caused this change; no lawsuits; no federal mandates. Nothing shows that our constituents will benefit from the higher costs and shortage of quality candidates.” Rep. Dan Itse, R-Fremont, said the change in the rules has created a new hiring problem for school districts across SAVE THE DATE the state. The N.H. School Nurses Association and the New Student Nurse Conference Hampshire Nurses Association supports the new requirements and urged lawmakers to keep them in March 27, 2018 Excellence in Nursing Presort Standard Awards Banquet US Postage PAID May 22, 2018 Permit #14 Princeton, MN Spotlight on Nursing current resident or 55371 June 21, 2018 2nd Annual Healthy Nurse 5K Run October 20, 2018 Page 2 • New Hampshire Nursing News April, May, June 2018 Guidelines for Submissions to NH Nursing News

NH Nursing News (NHNN) is the official publication to [email protected] with NN New Hampshire of the NH Nurses’ Association (NHNA), published Submission in the subject line. quarterly – and available in PDF format at our website: NURSING NEWS www.nhnurses.org. Views expressed are solely Publication Selection and those of the guest authors or persons quoted and do Rights: not necessarily reflect NHNA views or those of the Articles will be selected for publisher, Arthur L. Davis Publishing Agency, Inc. publication based on the Vol. 42 No. 2 NHNA welcomes submission of nursing and health topic of interest, adherence Official publication of the New Hampshire Nurses’ related news items, original articles, research abstracts, to publication deadlines, Association (NHNA), a constituent member of the and other pertinent contributions. We encourage short quality of writing and peer American Nurses Association. Published quarterly summaries and brief abstracts as well as lengthier review. *When there is every January, April, July and October. Library reports and original works. An “article for reprint” may space for one article and two subscription rate is $24. ISSN 0029-6538 be considered if accompanied by written permission of equal interest are under review, from the author or publisher. Authors do not need to be preference will be given to NHNA members. Editorial Offices NHNA members.* NHNA reserves the right to edit articles to meet style New Hampshire Nurses Association, 25 Hall St., Unit and space limitations. Publication and reprint rights 1E, Concord, NH 03301. Ph (877) 810-5972, E-mail Manuscript Format and Submission: are also reserved by NHNA. Feel free to call us any [email protected] Articles should be submitted as double spaced WORD additional questions at 877-810-5972. documents (.doc format vs. .docx, please) in 12 pt. font Editor: Susan Fetzer, RN, PhD without embedded photos. Photos should be attached Advertising: separately in JPG format and include captions. Product, program, promotional or service NHNA Staff announcements are usually considered advertisements Joan Widmer, Nurse Executive Director Submissions should include the article’s title plus vs. news. To place an ad, contact: Arthur L. Davis author’s name, credentials, organization / employer Publishing Agency, Inc. Email [email protected] or NURSING NEWS is indexed in the Cumulative Nursing represented, and contact information. Authors should call 800-626-4081. Ad sales fund publication and Index to Nursing and Allied Health Literature (CINAHL) state any potential conflict of interest and identify any mailing of NH Nursing News and are not paid to and International Nursing Index. applicable commercial affiliation. Email as attachments NHNA. For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, [email protected]. Exeter Hospital Hosts Magnet Appraisers NHNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Seeking a second Magnet designation, Exeter Hospital Studies show that higher nurse-to-patient ratios and the Responsibility for errors in advertising is limited to hosted the American Nurses Credentialing Committee professional practice environment in Magnet facilities corrections in the next issue or refund of price of (ANCC) Magnet Appraisers in February 2018. The result in fewer complications, lower mortality rates, advertisement. journey to Magnet Excellence is as important as the and shorter stays. Needlestick-related, pressure-ulcer, destination. The Magnet journey reframes the question and nosocomial infection rates are also lower. A Gallup Acceptance of advertising does not imply for the future from “What do you do?” to “What survey found that nurses in Magnet hospitals not only difference have you made?” After a comprehensive have significantly higher job satisfaction than those at endorsement or approval by the New Hampshire application of supporting documents, appraisers non-Magnet facilities, but also a significantly higher Nurses Association of products advertised, the compare the materials submitted against the 5 Magnet desire to remain in their position. Higher job satisfaction advertisers, or the claims made. Rejection of an principles. The three appraisers make a site visit after means less burnout. The study estimates Magnet advertisement does not imply a product offered for the document has been accepted to verify and ask hospitals experience 1.7% less turnover than the industry advertising is without merit, or that the manufacturer questions. average. lacks integrity, or that this association disapproves of the product or its use. NHNA and the Arthur L. Magnet Recognition® from the American Nurses The New Hampshire Nurses Association congratulates Davis Publishing Agency, Inc. shall not be held liable Credentialing Center (ANCC) is the highest and most Exeter nurses on their second Magnet journey. for any consequences resulting from purchase or use prestigious distinction a healthcare organization can of an advertiser’s product. Articles appearing in this receive for nursing excellence and high-quality patient publication express the opinions of the authors; they care. Only 8% (451) of U.S. hospitals have earned do not necessarily reflect views of the staff, board, Magnet designation, with only 3 Magnet facilities in New or membership of NHNA or those of the national or Hampshire: Southern New Hampshire Medical Center, local associations. Wentworth Douglass Hospital and Exeter Hospital. Redesignation is required with the documentation submitted every three years.

VISION STATEMENT

Empower New Hampshire nurses as leaders in advancing the profession of nursing and the health of New Hampshire.

REGISTERED NURSES MISSION STATEMENT Full Time & Part Time – All Shifts Psychiatric Specialty Areas: NHNA, as a constituent member of the American Nurses Association, exists to promote the practice, development Adult, Child/Adolescent, Geriatric & Crisis Stabilization and well being of NH nurses through education, empowerment and healthcare advocacy. Competitive Benefits & Pay Scale Adopted 10-20-2010. Extensive Paid Orientation Recent Graduates Welcome!

View job specifications and how to apply 35 Tilton Road • Tilton, NH 03276 Mark Mallahan for external RN postings: www.belknapsubaru.com General Sales Manager [email protected] http://das.nh.gov/jobsearch/Employment.aspx (603) 729-1300 New Hampshire Hospital (800) 358-4029 NH Department of Health and Human Services Fax (603) 729-1301 36 Clinton Street Concord, NH 03301 Human Resources 603-271-5855 April, May, June 2018 New Hampshire Nursing News • Page 3 PRESIDENT’S MESSAGE

Congratulations! There is a paid lobbyist for nearly fifteen years. Nurses were always ask the candidate to tell us about an innovative a powerful momentum instrumental in helping to pass Medicaid expansion solution at a work site or patient care challenge. Usually building in nursing. For in NH and we continue to be a trusted resource when the response is silence and sometimes hand wringing. sixteen consecutive years it comes to health and health care policy. Each year I always reassure them that they likely do something nurses have been ranked the we meet with legislators during a breakfast at the innovative every day. Inevitably they tell us about how most “honest and ethical” State House, and you will find a companion article they did something simple but incredibly creative to profession. More and more summarizing the successful Legislative Town Hall Forum, help a patient achieve their goal. we are being brought to which had record attendance for 2018! Our Commission the table and recognized as on Government Affairs led the way in these initiatives. Lastly, the influence of nurses on their patients, families, leaders and experts in patient colleagues, communities, and key decision makers is care and health care; serving Next, I think of patients inspiring nurses by sharing local, global and exponential. The influence is why the on boards and promoting poignant moments with them and nurses inspiring their Healthy Nurse Heathy Nation initiative is so important. public policy. We will also patients to reach their optimal wellness. I also think Based on ANA’s 2016 Health Risk Appraisal, nurses Carlene Ferrier take advantage of the “open of nurses inspiring nurses. Recently I had the honor scored lower compared to general population in mic” that the #Me-too campaign has allowed, and hope of judging nurses in several categories for the “Nursing every category except smoking. There are 3.6 million to #EndNurseAbuse in America. In tying this all together, in Excellence Awards.” For the first time in New Registered Nurses. If nurses become healthier, we the American Nurses Association (ANA) has named Hampshire, NH Magazine is planning a story on the will increase the health of the nation. Are you able to 2018, the Year of Advocacy, #BedsideAndBeyond and best nurses in NH in thirteen different categories, just commit to one lifestyle change to improve your health the theme for National Nurses Week is: “Nurses inspire, in time for National Nurses Week. As with any activity in 2018? innovate, influence.” What do you think about, when you volunteer for, you usually “get more in return” than you think of nurses acting in those roles? you give, but you never know what that might be, and At NHNA, we strive to influence the spread of that is what makes it fun. That was just the case for this advocacy, nurse innovation, and to inspire you where Let’s start with advocacy since this is the theme for program. I spent the better part of a cold NH weekend you live, learn and work. Prior to the 2018 Annual this year. All nurses advocate for their patients at reviewing submissions and scoring nominees not Meeting in the Fall, we will be hosting a conference the bedside, and many more nurses are becoming knowing how inspired I would be. I was filled with pride to highlight the innovative work our nurses are doing involved in advocating for our patients or population for my profession when I read about the amazing work all over NH to improve health, health care and create through legislation. If you haven’t experienced the thrill nurses are doing in the mountains, valleys, cities and a balanced work environment. Why does this matter? of helping to pass legislation, I highly recommend it. towns of New Hampshire to improve patient outcomes Did you read about the most popular course at Yale Imagine the joy you feel when you help your patient and support their colleagues. this year? Happiness. Research show that being healthy, reach their health goal, then magnify it by the number having a meaningful life and creating a positive social of people who will be positively impacted because of Nurses also innovate every day but we have a hard time network leads to happiness. Focus on your health and a public policy. NHNA has a long history of walking admitting we are innovative because it comes so natural get involved. Let NHNA help you and you will be glad the talk. We have made the financial investment of to us. In my work area, during an interview board, we you did.

FROM THE ED’S DESK

The past year has been marked by turbulent political Riverwoods, NH Hospital, Bedford Nursing & Rehabilitation Center, VNA Health times. That is why I was very encouraged by the turnout System of Northern New England, Concord Hospital, Eastern Maine Healthcare for NHNA’s 2018 Legislative Town Hall Forum. Despite Systems and Brattleboro Retreat. As you can see by a few of our sponsors, NHNA is weather challenges, over 230 nurses and nursing students gaining recognition beyond our state boarders. gathered at 16 locations around the state to listen to the Commission on Government Affairs (CGA) discuss I am also excited to announce that NHNA is currently working on a new program, legislative issues of importance to nursing practice and targeted for the emerging nurse. The emerging nurse is a nurse with 2 to 5 years of health care. The members of the CGA did a fabulous job experience, who is clinically competent and starting to ask “What is next for me?” of explaining each of the bills presented at the Forum and We are fortunate to have teamed with Elliot Health Systems in planning this program. Pam DiNapoli, Chair of the CGA, guided the program from Watch our website for more information as we develop this program. start to finish. I was even more thrilled to read some of the participant comments regarding the event; comments Joan such as: this program was “a reminder of how much our Joan Widmer voice can count,” and “it is a fantastic way for nurses to get involved in social and health policy advocating,” and “the benefits of collaborating with a team of nurses working towards improving health and access to care is very empowering.” Collectively, nurses have a powerful voice for health care and it was very rewarding to see New Hampshire nurses exercise that voice.

I have been fortunate over the past few months to participate in many public hearings regarding the various bills which NHNA is following. It has been very interesting to listen to the thoughtful questions posed by New Hampshire legislators and gratifying to see their responsiveness to testimony presented by nurses. Nurses have many stories to tell and nursing has been recognized as the most trusted profession by the Gallup Poll for the past 16 years. New Hampshire legislators recognize these attributes and truly listen when we speak.

In December, NHNA and New Hampshire Magazine launched the first Excellence in Nursing Awards. As noted in the companion article, ninety-eight applications were received across thirteen nursing categories. I was privileged to be one of the reviewers for this program, and was thoroughly impressed by the caliber of the nurses in the nominations that I reviewed. New Hampshire is very fortunate to have so many accomplished and caring nurses. I am proud to be a member of this profession with so many accomplished nurses and am also looking forward to celebrating our profession at the Excellence in Nursing Awards banquet on May 22. I hope to see many of you there.

At the time I am writing this report, plans are well underway for the 2018 Graduating Student Conference and Career Fair. This program provides nursing students with important information for their transition from student to RN, as well as an opportunity to speak with many nursing recruiters. We are very fortunate to have so many nursing organizations sponsor this program for nursing students who are on the verge of entering the nursing profession. Organizational sponsors include Southern New Hampshire University, Elliot Health Systems, Southern New Hampshire Health, Catholic Medical Center & GraniteOne Health, North Country Healthcare, NSO, Cheshire Medical Center and the University of Rhode Island. Additional exhibitors include LRGH, Hurst Communications, Rivier University, Saint Anselm College, Page 4 • New Hampshire Nursing News April, May, June 2018 Overwhelming NHNA Shares a Breakfast with NH Legislators Response for Excellence in Nursing Awards

The New Hampshire Nurses Association (NHNA) legislators taking the time to sit down and discuss hosted a breakfast for New Hampshire legislators in various legislative issues of interest with NHNA the Capitol dining room on January 9, 2018. NHNA including Rep Paul Somero (Hillsborough, 25), Rep members included Pam DiNapoli, Chair of the Douglas Thomas (Rockingham, 05), Rep Donald Commission on Government Affairs (CGA), Carlene LeBrun (Hillsborough, 32), Rep Mariellen MacKay Ferrier, NHNA President, Bobbie Bagley, NHNA (Hillsborough, 30), Rep Kari Lerner (Rockingham, 04), Immediate Past President, Joan Widmer, NHNA Nurse Rep Burton (Strafford, 06), Rep Moffett (Merrimack, Executive Director and Representative Polly Campion, 09) and Senator Gary Daniels (11). Conversations Ad hoc member of the CGA. Bob Dunn, of Devine on school nurse certification, Medicaid expansion & Millimet, NHNA’s lobbyist, was also present, along reauthorization, lead paint and many other with Traci Fairbanks and Harriet Davenport, members topics could be heard. While the Democratic of the NH School Nurses Association. Representatives needed to leave around 8:00 am to attend a party caucus before the legislative Nominations for the Excellence in Nursing Awards Approximately eighty legislators came through session later that morning, many of the Republican closed on January 11th, providing nominators with an to enjoy the continental breakfast with twenty Representatives stayed for the discussion. extra week to submit their nominations due to inclement winter weather and winter holidays. New Hampshire Magazine and the New Hampshire Nurses Association (NHNA) were thrilled with the overwhelming response to the first Excellence in Nursing Awards. Ninety-eight nominations were received in over thirteen categories.

A team of sixteen nurse reviewers was named by NHNA and tasked with reviewing and scoring each of the nominations using a rubric that was previously vetted in our own award ceremony. Each nomination was scored by three or four reviewers and the winner for each nursing category was selected based on the composite score. Approximately half of the reviewers were nurse leaders from other ANA affiliated nursing organization. We are grateful to reviewers from our sister organizations: ANA-Vermont, ANA-Rhode Island, ANA- New York, ANA-California and the ANA-Colorado. Joan Widmer (back to camera) speaking with Pam DiNapoli (back to camera) and Rep Polly Many of these nurse reviewers commented on the Rep Paul Somero. Bob Dunn in foreground. Campion speaking with Senator Gary Daniels. difficulty of discerning between so many exemplary nominations.

During the month of March, Award winners were notified with awards to be presented at the Awards Reception on May 22 (5:30 – 7:30 pm) hosted by NH Magazine at the Radisson Hotel in Manchester. Tickets are on sale on the NH Magazine website (http://www. nhmagazine.com/nursingawards) at $55.00 each. Join the celebration of nursing in New Hampshire and an evening filled with great conversation, food, and celebration.

Carlene Ferrier (back to camera), Traci Fairbanks and Harriet Davenport (on left) chatting with legislators about HB 1217 and SB 434 April, May, June 2018 New Hampshire Nursing News • Page 5

IN MY OPINION NOW HIRING! Weekend RN Coordinator

Considering the Best Offense… On Call RN Call or Visit us at Visit Staff Let me start by acknowledging that I am not an avid of a football game are always seen on the sideline football fan. I do like the game, but I cringe when I see with headphones trying to learn about the opponent’s 603-524-8444 Staff Development/ the ACLs get torn or the brain concuss. Yet, I did manage players, opponent’s plays and their own vulnerabilities. www.centralvna.org Quality RN to get home after grocery shopping to As knowledge is power, it is also a defense watch the last half of Superbowl LII. And against ignorance. When was the last yes, I was cheering for the Patriots and time you picked up a nursing journal or Brady and Gronk. So what happened attended a nursing conference? was sad, but not unexpected. The best offense is a good defense. Linemen and linebackers must block The third best defense is malpractice the running game, give the quarterback time to throw insurance. And I don’t mean the facilities’ and make interceptions to give the winning team the ‘blanket’ insurance policy. You don’t “turn- advantage. Where was the Patriots defense? off” your nurse brains or behaviors when you leave the facility. When a quarterback has pass protection by Every nurse is a quarterback. We call plays, work with the linebackers he has the peace of mind and can take team mates for the best outcome and encourage the the time to pass successfully. Malpractice insurance is patient to cross the goal line. Like football, the best a small price to pay for peace of mind. If you work full nursing offense is a good defense. Three of the key time it amounts to less than 10 cents an hour. What a defensive weapons in nursing are colleagues, continuing bargain defense! Be careful that you use a company that education and malpractice insurance. specializes in health care malpractice. Adding a rider onto your home owners or car insurance may not be Nursing colleagues can support your efforts by enough to protect you. Companies like NSO (Nursing offering suggestions in the huddle and even lending Service Organization) offer quotes online. a hand. We hear a lot about incivility in nursing these days – speaking ill, picking on and sabotaging The Patriots will regroup, rethink and colleagues. Incivility begins in school as bullying but hopefully trade for some new being addressed as early as elementary grades. A bully defensive players. Do you have all of behaves uncivilly. What are you doing to make your your defensive positions covered? Do worksite better? It is everyone’s problem. you maintain respect and treat all of your coworkers as professionals? Do Continuing education is a must defense, it is both you routinely attend continuing protective and additive. Continuing education protects education programs and read nursing journals outside of the nurse from making an error of omission, e.g. “I the workplace? Do you hold malpractice insurance? In didn’t know.” Continuing education adds to the nurse’s my opinion, the best offense is a good defense. Sorry repertoire of offensive maneuvers. Assistant coaches ‘bout that Mr. Brady. Page 6 • New Hampshire Nursing News April, May, June 2018

The University of New Hampshire hosted Governor John Sununu during hosted an accreditation visit for its M.S.N. degree a recent visit to discuss resources for the opioid crisis. The Governor met Colby-Sawyer College with nursing students and toured the simulation lab facilities. program by the Commission on Collegiate Nursing Education (CCNE) in February 2018. The CCNE site visitors were accompanied by a NEASC accreditor as well as representatives from the New Hampshire Higher Education Commission. The Nursing program received 10 year CCNE accreditation in 2012 for the Baccalaureate program.

James McCarragher, RN, MSN, joined professor of Nursing and Public HealthColby following Sawyer more as assistantthan 20 years as an instructor at River Valley Community College. He holds a B.S. in nursing from the University of Connecticut and an M.S.N. from Case Western Reserve University.

Eight Saint Anselm College nursing students are completing clinical work in Costa Rica through the course, Community & Public Health Nursing (NU449). Led by nursing professor Pamela Preston, the junior nursing students are assessing families in the community to provide health education. The winter break trip is one component of the spring semester course, which explores the Rivier University has been awarded the HRSA Behavioral role of nurses in health promotion and disease prevention globally. Health Workforce Education and Training (BHWET) grant over the next four years through August 31, 2021. The purpose of this grant is to develop and expand the behavioral health workforce serving populations across the lifespan, including in rural and medically underserved areas. Rivier offers psychiatric mental health nurse practitioner program and a post master’s certificate. The grant is funding a $5,000 stipend to all students in their third practicum (final) experience and includes 2 workshops per year for students, faculty and preceptors.

The Board of Nursing released the results of the 2017 NCLEX pass percentage for New Hampshire Nursing Programs.

Pass Percent Colby Sawyer 100 UNH 100 White Mt CC 100 Lakes Region CC 100 Manchester CC 97.9 NHTI 97.9 Harmony Health Care Institute was granted full approval by the New Hampshire Board of Nursing based on 2 years of St. Anselm 96.9 Rivier 92.7 satisfactory reports to the Board regarding program progress River Valley CC and NCLEX scores at or above the national average. Harmony 92.0 prepares practical nurses. Great Bay CC 89.4 Nashua CC 87.5 Mass College 85.5 St. Joseph’s 80.1 Plymouth State 80.0 Keene State 75.8

New Hampshire Average 90.9 National Average 87.1 ED Note: News from nursing schools, faculty, students or alumni are welcome. Please direct submissions to [email protected] with NHNN in the subject line. April, May, June 2018 New Hampshire Nursing News • Page 7

NURSES ON THE MOVE

Dr. Bernadette Y. Jao was Services which includes both the surgical and endoscopy Nursing at Concord Hospital. She holds a BSN from the appointed as the Director of services at Elliot Hospital and at the Elliot at River’s Edge. University of Wisconsin-Eau Claire and a MSN from the Patient and Nursing Services at University of South Alabama. the Veterans Affairs (VA) * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Manchester Medical Center * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * effective January 22, 2018. Jao Rachel Chaddock, RN BSN, Amy Davis, MN, APRN, FNP-BC has 17 years of experience with MSHSA was appointed Vice has accepted a position as an the VA system, most recently as a President, Visiting Nurse advanced practice nurse in nurse leader at the Wilmington Association of Manchester and Occupational Health at Littleton Delaware VA Medical Center. Southern New Hampshire. Regional Hospital. Davis holds a She received a BSN from the Chaddock holds a BSN from the BA from Ohio Wesleyan University of the City of Manila, Philippines, a MSN from University of Lowell with and a University and a BSN from the University of Phoenix and a DNP from Old master’s degree in health services Salisbury University. A MSN and Dominion University. She is board certified as a administration from the Family Nurse Practitioner psychiatric and mental health nurse. As a graduate and University of Massachusetts. She Certification was obtained from member of the VHA internal consultants’ team, she has began her career as a home care Montana State University in 2014. been serving as a Mental Health resource person for VA and hospice nurse. From 1994 to 2009 she served as the Medical Centers. Director of the VNA of Manchester and Southern NH, overseeing homecare and hospice clinical services, * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * marketing, quality, and home medical equipment and Beverly Rankin, RN, BSN, MSA, infusion services. BC-NE has been appointed as Jennifer Torosian, RN, MSN, Chief Nursing Officer of Valley NEA-BC as assumed the position * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Regional Hospital effective of Interim Chief Nursing Officer February 12, 2018. With over 36 at Catholic Medical Center. Martha Leighton, RN, MSN has been appointed as Senior Vice years of experience Rankin was Torosian has held various most recently the CNO of Alice leadership positions at CMC President and Chief Nursing Officer of the Elliot Health Peck Day Memorial Hospital in since 2008. She was formerly the Lebanon. She holds a BA and BS Director of Clinical Practice at St. System. Leighton has practiced at Elliot for over 22 years, serving in from the University of Guelph in Joseph’s Hospital. She holds a Ontario, as well as a BS in MSN from Quinnipiac University. a variety of roles including staff nurse, educator, Perinatal Safety Nursing from McGill University in Montreal and a Master of Science in Administration from St. Michael’s * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Nurse, Clinical Nurse Leader, and from 2013 to 2016, the Patient College in Colchester, Vermont. Rankin is certified in Safety Officer. For the past year, Nursing Administration. Former CNO Robert Duhaime, she has been the Interim Chief Nursing Officer. She * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * RN, MSN, MBA retired in obtained her MSN from UNH. September 2017 and has Ed Note: Have you accepted a new position? Send your accepted a position as a Joint * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * information to [email protected] – your colleagues want Commission visitor. Duhaime to know! also served as a member and Jean Ten Haken, RN, MSN has chair of the New Hampshire accepted a position as Chief Board of Nursing. Nursing Officer at Alice Peck Day Memorial Hospital. Ten Haken most recently served as the Chief Are You Over 50? * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Operating Officer at the Elliot Health System in Manchester, Beverly Primeau, RN, MBA, New Hampshire, where she also Mammograms and CRNFA, CASC has been served as the Vice President of Pap Tests for promoted to Vice President Patient Care Services and Chief FREE Eligible Women Surgical and Procedural Services Nursing Officer. She began her of Elliot Hospital. Primeau began management career at Dartmouth-Hitchcock Medical her career at Montreal General Center, as the Director of Intermediate Cardiac Care and Call 1-800-852-3345 Hospital where she was an Cardiovascular Critical Care Units. Prior to joining the Department of Health and Human Services or 603-271-4931 operating room nurse. Shortly Elliot, Ten Haken was the Vice President of Acute Care Division of Public Health Services after moving to Florida, she founded Helping Hands Surgical First Assistants in Ormond Beach, a professional association that provided surgical first assistants to 25 surgeons and had exclusive contracts with 3 area hospitals to cover all C-sections. She then joined St. Lucie Medical Center in Florida where she oversaw a 7 room OR/PACU. She participated in the JOIN OUR TEAM start of the Concord Ambulatory Surgery Center where she was a Director. She has been at Elliot Health System since the spring of 2015 as the Director of Surgical at Northeastern Vermont Regional Hospital, located in Vermont’s historic and rural Northeast Kingdom! NVRH is REGISTERED NURSES proud to offer a positive working community in which to Full time or per diem opportunities available for: grow, learn and excel in your profession. Labor & Delivery Inpatient Care Unit Various Nursing and Nurse Practitioner positions are Emergency Department currently available in Med/Surg, Emergency Services, Psychiatric/Behavioral Health The Department of Nursing at Saint Anselm College, a Roman OR, Day Surgery and Physician Practices. Physician Practice Catholic undergraduate liberal arts college in the Benedictine New grads are welcome and encouraged to apply. tradition in Manchester, NH invites applications for a part-time clinical position in medical surgical nursing, to begin August 2018. To view all current job opportunities, The successful candidate will instruct nursing students in the clinical For a full listing of available positions and to and to apply please go to: setting (2 days a week). Please submit a letter of interest and resume complete the online application, visit the Employment to the attention of Dr.Maureen O’Reilly, Executive Director of Opportunities pages at www.NVRH.org. www.springfieldmed.org/careers Nursing via the college website at www.anselm.edu/hr. 401(k), health/dental/vision, life, short and long-term disability, wellness program, massage therapy, acupuncture, skin care, hypnotherapy, fitness Prior to interview three letters of recommendation and academic NVRH offers competitive wages, shift differentials, per diem center and weight watchers reimbursement, educational loan options, tuition transcripts are required. Applications should be received by premiums and a generous benefits package for PT and FT reimbursement and much more. June 1, 2018 for full consideration. employees working 20 or more hours per week . A Master’s degree is required. Recent clinical experience in Benefits include medical, dental, vision, 401K retirement Happy National Nurses Week! medical-surgical nursing is also required. plan, tuition reimbursement, paid vacation days, Successful candidates will be able to assist the college membership to local gyms and more . to further its strategic goals for institution-wide 25 Ridgewood Road, Springfield, VT 05156 diversity and inclusiveness. NVRH is an Equal Opportunity Employer 802-885-7634 Equal Opportunity Employer Page 8 • New Hampshire Nursing News April, May, June 2018 LEGISLATIVE UPDATE 2018 Legislative Town Hall Forum

On a rainy January evening, approximately 200 nurses The program was opened by moderator Pamela along with NHNA’s position on each bill. DiNapoli gathered at 16 locations around the state to participate DiNapoli, Chair of the Commission on Government shared information regarding the process by which the in the New Hampshire Nurses Association’s 2018 Affairs (CGA). Dr. DiNapoli delivered introductory members of the CGA reviewed the legislative bills and Legislative Town Hall Webinar Forum hosted at Granite remarks in a presentation called, “Your Role in Health how the targeted bills were selected for presentation at State College (the home of NHNA’s office). Due to the Policy and Advocacy.” The presentation was authored the Forum. At the conclusion of the bill presentations, weather the video link was also proved to all registered by Bobbie Bagley, NHNA’s Immediate Past President each host site host was asked to engage participants in attendees offering them the opportunity to view the who was unable to present due to the inclement discussion about the bills presented. Each participant event, but not participate in the discussion, from home. weather. The program continued with NHNA lobbyist, was given the opportunity to vote on their top three Thirty-five attendees participated at home. NHNA will Robert (Bob) Dunn Esq., of Devine Millimet, who priority pieces of legislation. The top three priorities continue to explore ways to use technology to expand presented a state of the state address, sharing with selected by all attendees – opportunities for nurses statewide to fully participate. the audience his thoughts on the New Hampshire • Passenger Restraint bill (HB 1259) legislative environment. Bob Dunn was then joined • Medicaid Expansion Reauthorization (HB 1811) by a panel of experts, who each gave a few remarks • Pharmacist authority to dispense oral on their role in advocacy or the legislative process. contraceptives (HB 1822). Members of this year’s panel were, Carlene Ferrier, NHNA’s President, Denise Nies, Administrator for The top three priorities selected by registered nurses the NH Board of Nursing, Polly Campion, State and NHNA members: Representative from Grafton and ad hoc member of the • Medicaid Expansion Reauthorization (HB 1811) CGA and Mary Bidgood-Wilson, Executive Director of • Telemedicine bill (HB 1471) the New Hampshire Nurse Practitioners Association. • LNA disciplinary reports (HB 1556) (In opposition) The main purpose of the forum was to present pending legislation from this current legislation session to the The CGA provides weekly updates on these bills and NHNA members and attendees. Fourteen bills (see others that may come to the attention of the CGA on insert)) selected by the CGA members were presented the NHNA website: www.nhnurse.org (Advocacy tab). Participants at Granite State College included Pam DiNapoli (at the podium), and the panel (right to left) Bob Dunn, Rep. Polly Campion, Denise Nies, Mary Bidgood-Wilson and Carlene Ferrier

Participants at Littleton Hospital, the Rural Nurse Organization included (left to right bottom) Amanda Graves Student Nurse; Dayle Sharp; Patti Pucilli; (top) Erin Hennessey, NH State Participants at Dartmouth Hitchcock Representative, Cathie Flores; Kyle Sanborn, Participants at Cheshire Medical Center Student Nurse and Olivia Piraino, Student Nurse

New Hampshire Nurses Vote Top Bills to Watch

HB 1259: An act relative to passenger restraints. out that even without a mandate, NH traffic fatality Board of Nursing any pending criminal charges, rates have been steadily declining. criminal convictions, or plea arrangement they have A bill requiring passenger restraint use by all motor negotiated. HB 1556 sets to limit an applicant’s vehicle operators and passengers unless specifically NHNA’s Position: In Favor requirement to report charges, conviction, or plea exempt by law. New Hampshire is the only state in arrangements only to those concerning violent crimes, the US without a primary or secondary law requiring HB 1556: An act relative to licensing requirements for and criminal neglect of elderly, disabled, or impaired adult motorists to wear seat belts. No legislative barbers, cosmetologists, estheticians, and licensed adults. HB 1556 would prevent the Board of Nursing action on this issue has been taken since 2009, nursing assistants. from receiving notice that applicants have charges, when a bill requiring adult seat belt use passed the convictions, or pleas arrangements except for in the House but was defeated in the Senate. Proponents HB 1556 seeks to ensure that barbers, cosmetologists, narrow circumstances of violent crimes or criminal of a mandatory seat belt law argue that it would save estheticians, and licensed nursing assistants are not neglect. HB 1556 seeks to limit the authority of the lives, reduce injuries, and save the state, the federal barred from employment even if these individuals Board of Nursing to discipline licensed nursing government, and insurance companies millions of have a criminal history, so long as the crimes are not assistants or applicants for licensure. dollars. Opponents counter that the choice to wear a violent crimes. Currently, applicants for a licensure seat belt should remain up to the individual, and point as a nursing assistant, are required to report to the NHNA’s Position: Oppose, recommend removal of LNA’s from its provisions.

NEW HAMPSHIRE DEPARTMENT OF CORRECTIONS IS LOOKING FOR: REGISTERED NURSES Northern NH Correctional Facility in Berlin Secure Psychiatric Unit at NH State Prison in Concord R NH Correctional Facility for Women in Goffstown GEN N’s a nted! D! ERO nd LNA’s Wa FERE US SIG ES OF RN I: $49,316.80-$58,094.40 PLUS 15% N-ON BONUS INCENTIV INCREASE ON TOP RN II: $53,539.20-$62,982.40 OF BASE SALARY Full-time positions available. Great starting pay RN III: $58,094.40-$68,952.00 with raise in 90 days! Excellent benefit package for (Salary does not reflect Hazard Duty, applicable Shift differential, and/or Weekend pay) those who qualify including health, dental, life, 401k Provides general nursing care and treatment in an adult ambulatory setting, inpatient with employer match, disability, prepaid legal, shift infirmary unit, and/or in an inpatient psychiatric forensic unit under the direction of the differentials, generous PTO plan and more! Must nurse coordinator . Correctional nursing requires ongoing close and immediate contact with prisoners and/or civilly committed residents while maintaining safety and security . have valid NH RN or LNA license. Locations are secure facilities managed by the NH Department of Corrections . Please submit application to Human Resources, Please apply on line at www.nh.gov. Click on the job opportunities icon Webster at Rye, 795 Washington Road Rye, NH 03870 and follow the instructions to Register; create a complete profile and save. Log In and apply. Questions may be directed to Linda McDonald at or email to [email protected]. 603-271-5645 or via e-mail at [email protected]. April, May, June 2018 New Hampshire Nursing News • Page 9 LEGISLATIVE UPDATE

Table of Bills Presented at the 2018 Legislative Town Hall Forum Thanks! Bill Description Presenter NHNA Position NHNA extends its appreciation to the site Rescinds school nurse certification requirement passed coordinators for all their assistance in making this HB 1217 Pam DiNapoli Opposed in 2016. event possible, both for promoting the event at their Regarding school nurse appointments; revises location, preparing all the handouts for the event SB 434 Pam DiNapoli In Support and serving as discussion lead for their location. certification requirements for school nurses. 2018 site coordinators: Deb Hastings (Dartmouth- Commission on Workforce, adds an NHNA appointee SB 426 Laurie Harding In Support Hitchcock Medical Center), Jennifer Nason (Concord as a member of this commission. Hospital), PattyAnn Labrie (Catholic Medical Center), Removes requirement that a Director of LPN program Kris Irwin (Elliot Hospital), Barbara Cormier (CGA HB 1703 Sherrie Palmieri Opposed Member, Manchester Community College), Karen must hold a Master’s degree Tollick (Southern New Hampshire Medical Center), Regarding passenger restraint laws; requires all vehicle Carole Boutin (Nashua Community College), Jean HB 1259 occupants to be restrained, regardless of age (current Susan Smith In Support Hayes (St. Joseph’s School of Nursing), Judi O’Hara law only applies to those under 18). (Rivier University), Amy Matthews (Cheshire Medical Regarding the drug take back program; adds illicit drugs Center), Kris Hering (Speare Memorial Hospital), HB 1457 Briana White and drug paraphernalia to the program. Holly McCormack (Cottage Hospital), Angela Katis (Portsmouth Regional Hospital), Pamela Kallmerten Regarding telemedicine; provides updated definitions (University of New Hampshire) and Catherine Flores HB 1471 and requires appropriate telemedicine services to be Cynthia Cohen In Support (Rural Nurse Organization at the Northwoods Center recognized as reimbursable by insurers. on Continuing Education). Regarding LNA disciplinary reports; seeks to limit crimes HB 1556 barring licensure to only violent crimes. NHNA wants Davida Rubin-Baker Opposed NHNA also thanks event sponsors: Dartmouth- LNA’s removed from the provisions of this bill. Hitchcock Medical Center (DHMC) and Granite State College (GSC). Both of these organizations provided Regarding Alternative Recovery Monitoring Program; the technical staff needed to make this event possible, HB 1571 seeks to establish a program for NH nurses that Pam DiNapoli In Support including Ray Kulig (DHMC), Mike Rizzo (DHMC) and voluntarily seek assistance. Edward Connor (GSC). Relative to protective orders for elderly & disabled; adds HB 1807 the ability to issue a protective order to safeguard the Joan Widmer In Support elderly, disabled or impaired adults to existing statutes. Relative to oral contraception dispensed by pharmacists. This bill seeks to create statutes that reflect the HB 1822 Sara Kellogg-Meade In Support recommendations of the Commission formed by HB 264 in 2017. Companion bill to HB 1822; requires insurers to allow SB 421 Sara Kellogg-Meade In Support for 12-month prescriptions for oral contraceptives. Medicaid Expansion Reauthorization (Sen Bradley bill). SB TBD Joan Widmer In Support Senate version of Medicaid Expansion Reauthorization Medicaid Expansion Reauthorization (Rep Rosenwald HB 1811 bill). House version of Medicaid Expansion Joan Widmer In Support Reauthorization. Participants at St. Joseph’s School of Nursing

HB 1811: An act relative to the New Hampshire health and Gynecology, has had a position statement NH Pharmacists Association, NH Independent protection program affirming that over-the counter contraceptives Pharmacy Association, Coalition of NH Chain Drug should be available for women. The Food and Drug Stores, NH Society of Health-System Pharmacists, NH first passed Medicaid Expansion to provide Administration has not approved over-the-counter NH Nurse Practitioner Association, NH Hospital coverage for adults 18-65 with incomes up to 138% access. House Bill 1822-FN bill was developed within Association, Planned Parenthood of Northern New of the Federal Poverty Level in 2014. This program the context of an interdisciplinary Commission to England, Bi-State Primary Care and NH Department was reauthorized in 2016. However, without another study pharmacist-accessed hormonal contraceptives of Health and Human Services. reauthorization the program is scheduled to sunset on as a means to improve access. December 31, 2018. Since its passage, an additional NHNA’s Position: In favor. 125,000 NH residents have secured health care The Commission reviewed other states experiences coverage under its provisions; with 50,000 individuals with this practice and reviewed NH experiences HB 1471-FN: An act relative to telemedicine currently enrolled in the program. with standing orders and protocols for other clinical circumstances. House Bill 1822-FN represents the A bill requiring appropriate tele-medicine services NHNA’s Position: In favor. As of February 8, 2018 product of the Commission’s work and unanimous to be recognized as reimbursable by insures. the bill was referred for interim study, placing it on agreement by the Commission. Participants in the Telemedicine is a growing method of healthcare hold. Commission included representation from NH Boards delivery. It allows patients to receive quality of Nursing, Medicine, and Pharmacy, American healthcare regardless of location, time, and HB 1822-FN: An act making hormonal contraceptives College of Obstetrics and Gynecology, New availability of specialty medical services. available directly from pharmacists by means of a Hampshire Nurses Association, NH Medical Society, standing order NHNA’s Position: In Favor. Historically oral and other hormonal contraceptives required a visit to a primary care or women’s health care provider, during which time a prescription is written for hormonal contraceptives. In the last five years ACOG, the American College of Obstetrics

Maplewood nursing needs: SAVE THE DATE • SAVE THE DATE • SAVE THE DATE 11th Annual LNAs LNA’s are needed for our 3pm-11pm shift and NEONE Nurse Educator Symposium 11pm-7am shift. Baylor position for these shifts as well. Keynote Speaker: Michele Deck RN Supervisor It’s all About Engagement We are looking for an RN Supervisor 11pm-7am. Friday, April 13, 2018 This comes with a $3,500 sign on bonus. Hilton Garden Inn • 5 Wheeler Road • Burlington, MA 01803 LPNs and RNs For more information: please contact Chris Bone at LPNs and RNs needed for 3pm-11pm and 11pm-7am. [email protected], 603-580-7443 or visit neone.org cheshirecounty.us/maplewood SAVE THE DATE • SAVE THE DATE • SAVE THE DATE Page 10 • New Hampshire Nursing News April, May, June 2018 TEACHING BACK TONIGHT…Try this!

Wendy Gladstone, MD Other protective factors include routine prenatal care, no positioners that are advertised to help avoid “crib smoke exposure, avoiding overheating and breastfeeding. death” (in fact, they do the opposite). Is there a 10 pound bag of flour in your cupboard? Bet The presence of a fan in the room and the use of a • Well-meaning guests at baby showers often don’t you could find a big book that’s just about as hefty. Try pacifier have also been shown to be associated with a know that the gifts they are giving are dangerous this: lie down on your bed and put that weight on your lower risk of infant death. to infants. One of the first tasks a parent has is chest. Now try to breathe. It’s not easy! In a few minutes to keep unsafe objects away from a helpless you will find yourself working really hard to get enough newborn. air in and out. Now imagine you’re a 15 pound baby • Travel can take a family to where the usual with a load like that on your chest. That’s what it feels safe sleep set-up is missing. Planning ahead is like when a big adult drapes their arm over an infant essential to protect vulnerable babies. And they’re sharing the same bed. It doesn’t take long for the baby ALL vulnerable. to be in big trouble. Every year in the US, thousands of • Dealing with an unpredictable infant who can babies die in this and similar unsafe sleep environments. cry for hours at a time at all hours of the night is exhausting. It’s understandable that a stressed Don’t let your littlest patients be part of those terrible Understanding why parents don’t follow these guidelines caregiver will sometimes do whatever necessary statistics. Help parents understand that babies need a will help you make the best recommendations on safe to get the baby to settle down and sleep. But safe place to sleep, every time they sleep. sleep: there are alternatives to snuggling the infant in • Some parents think co-sleeping is “natural.” the adult’s bed or on a recliner or sofa. Because “Safe” means: When they learn that it raises a baby’s risk of nobody wants to wake up next to a baby that’s • sleeping on their backs suffocation and death, they are usually willing to not breathing. • on a firm, flat surface rethink this approach. • in an approved, empty crib or bassinette • Some parents aren’t aware that soft items in an Wendy Gladstone, MD, FAAP, is a retired pediatrician • in the same room as the caregiver(s) infant’s sleep environment can cause entrapment and a member of three state Fatality Review (room-sharing but not bed-sharing). and suffocation. This includes cute stuffed toys, Committees: analyzing the factors involved in the deaths cozy blankets, crib bumpers, pillows and even of infants, children and youths.

Catholic Medical Center OR nurses earned the Alice Peck Day Hospital recognized four nurses who CNOR® Strong designation from the Competency completed a Nurse Residency Program: Megan Wallace, & Credentialing Institute (CCI). The CNOR® Strong RN and Rebecca Fellows, RN (Med/Surg), Caitlin designation is given to facilities that have at least 50% of Bandy, RN and Jessica Chouinard, RN (PACU/SDS) its operating room nursing staff CNOR certified and that reward and recognize its certified nurses. Free Education on the Impact of Addiction

Drugs are everywhere. More and more patients * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * are affected by drug use, dependence or addiction, Adam Rembisz, RN, MSN, trauma program manager at or they have family members with substance use Elliot Hospital and Jessica Thonis RN, a nurse at Elliot problems. The New Hampshire Bureau of Drug * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Hospital appeared on WMUR. The news reported on and Alcohol Services is now offering free training their program to teach Manchester’s school nurses how to help providers and health care staff better to apply a tourniquet and how to use quick-clotting understand the neurologic basis of addiction and At Chesire Medical Center, gauze if a life-threatening injury should happen. All the broad-reaching mental, physical, emotional Liz Lajoie, RN, Case Manager, of the school nurses who participated took home kits and spiritual effects of drug dependency. The was awarded the Second packed with everything needed to stem bleeding. program covers the stages of change, intervention Quarter President’s Service The training was prompted by mass shootings across strategies and resources to help patients deal with Excellence Award. Hilary the country and is intended teach people how to drug and alcohol use. To learn more about these Brown, RN, Clinical Leader, prevent deaths from uncontrolled bleeding before first and other educational opportunities, log on to Cardiology and Lisa Kopcha, responders arrive. the Department of Health and Human Services’ RN, Clinical Leader, Kingsbury website at https://www.dhhs.nh.gov/dcbcs/bdas/ Unit were the recipients of the * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * training.htm. Leadership Award. Sherrie Palmieri, RN, DNP, participated in a panel Liz Lajoie, RN presentation representing the ANA at the 2nd International Specialty Nurses Conference held in Hangzhou, China in December 2017. Over 1500 nurses attended to hear about Healthy Nurse, Healthy Nation, Pathway to Excellence Program, Continuing Professional Nursing Opportunities at HCS Development for Specialty Nursing Practice, and Discover the rewards of one-on-one Developing Future Nursing Leaders. care, while working independently within a supportive clinical care team! * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Positions available in a variety of settings: Susan Fetzer, RN, PhD, presented the results of a • Home Care • Hospice • Wellness research study at the International Conference of • Private Duty • Pediatrics Perianesthesia Nurses in Sydney Australia in November, 603-352-2253 • [email protected] Vanessa, RN Home Health Nurse 2017. In addition, she was the keynote speaker at a Home Healthcare, Hospice & Community Services is a two day workshop at Kaohsiung Medical University, Monadnock United Way agency serving southwestern Hilary Brown, RN Lisa Kopcha, RN Kaohsiung, Taiwan for the Taiwan Nursing Education on New Hampshire communities with offices in Simulation in Nursing in December, 2017. Peterborough, Keene and Charlestown. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * April, May, June 2018 New Hampshire Nursing News • Page 11 IN HONOR OF... Peggy Lambert, RN Pamela DiNapoli

Peggy Lambert, Past President of NHNA, announced her retirement from Catholic Medical Center on January 26, 2018. Peggy was a valuable team member of CMC throughout her 40 year career; critical care and cardiac nursing have been a lifelong passion. She was instrumental in beginning the open heart program at CMC, in addition to her role in countless projects and initiatives including the creation of the Heart and Vascular Interventional Unit, the implementation of 24/7 APRN coverage in the ICU, and the continuous collaboration between the ORs, ICU and cardiac program. Peggy has tirelessly worked to advocate and advance patient safety initiatives at CMC and was part of a workgroup to reduce acute kidney injury in catheterization and intervention patients. Her work was featured in subsequent presentations and publications on the topic. She was a force behind a nurse-driven discharge protocol to best meet patient needs for a comprehensive discharge without the wait. Additionally, Peggy celebrates a career filled with service to local, regional and national professional and community organizations. She was president of the Southern New Hampshire chapter of American Association of Critical-Care Nurses, treasurer and president of the New Hampshire Nurses Association, and secretary of the Child and Family Services of NH Board of Trustees. She has been published in peer-reviewed journals, and presented at national conferences. We wish Peggy well as she takes a breather before diving into new professional pursuits.

Peggy Lambert (Center) celebrates her retirement with colleagues.

Ed Note: Celebrations of retirement or other honors are welcome for this new feature “In Honor Of…” Do you have a nurse that has gone above and beyond as Looking for a change? a colleague or mentor? Write a short description of why they should be honored, and include a photo if available. Submissions should be directed to office@ nhnurses.org. You could be here!

You belong at Banner Casa Grande Medical Center! Here you can have the opportunity for a broad range of activities year round to keep your work/life balance, just a few examples that Casa Grande has to offer! • We have 200+ days a year of sunshine • you can get to the beaches in San Diego or Mexico within hours • options close by to enjoy skiing, hiking or snowboarding • museums and cultural centers in close proximity

BCGMC is a 141 bed acute care hospital in a growing area where you can live in a charming small historic town and yet still be minutes away from the excitement and urban areas of Phoenix and Tucson.

At Banner Health, we understand that talented health care professionals appreciate having options. We are proud to offer our more than 50,000 employees many career and lifestyle choices throughout our network of Cottage Hospital offers competitive compensation and benefits package with creative and flexible schedule options for your life. facilities. The people of Banner Health are focused on making healthcare Sign-on bonuses available. Visit our website for a full listing of easier and life better. In return, we are committed to excellence in personal current career openings. development for all our employees.

Talk to a recruiter directly regarding what Banner Health can offer you! Contact Donna Dioses at [email protected] or call 602-747-2526. Page 12 • New Hampshire Nursing News April, May, June 2018

From the Bookshelf Internet

Health Information & the Internet: Can it be Trusted?

Anita Pavlidis, MS, RN on what to watch for when browsing health related Some of my favorites sites are: sites. • American Diabetes Association Wondering what that rash means and don’t have time • Current date: “The health website should be (http://www.diabetes.org) for a trip to the doctors? Chances are, a diagnosis is frequently updated and should indicate the • American College of Cardiology just a click away. From symptom checkers to illness- date of the latest revision.” Jones says. Look for (https://cardiosmart.org) specific forums, tons of health information is now the dates at the bottom of the home page. • National Women’s Health Information Center available on the web says Anna Dickens in her article • Site owner: Any dependable health website (from the Department of Health and Human Better Health: Just a Click Away. But are all websites should make it easy to recognize who is Services) (https://www.womenshealth.gov/) to be trusted? Keep in mind that information on the funding the website and its content. Look for • US Department of Health and Human internet is not regulated for quality or accuracy and web addresses that end in – .gov, .edu, or Services (https://healthfinder.gov) that almost anyone can publish anything they wish .org which indicates government, educational • Center for Disease Control & Prevention on the web. or professional organizations rather than (http://www.cdc.gov) professional sites.” Typically, at the bottom of • NIH National Cancer Institute A 2012 PEW study found that 93 million Americans the page is an “About Us” page (https://www.cancer.gov/) have used the web to find answers to their healthcare • Contact information: The website should questions. According to a PEW survey conducted provide information that allows searchers to A brief word about a commonly used source for from 2000-2018, in 2000, 50% of all users used contact the website owners to ask questions, reference and research: Wikipedia. Phoebe Ayers a the internet as a resource for information, in 2018, comments, and concerns. If the site does not contributing member of The Wikipedia Foundation 9 in 10 American adults use the internet. The PEW have a contact page listed anywhere, it should offers advice and recommendations for evaluating Research Center estimates that 61%of the total be an immediate red flag. the quality of articles found on Wikipedia. Wikipedia population uses the internet and of those 83% of the • Possible bias: Is the purpose of the website is a very popular online encyclopedia and its articles online population seek health information with the clear? What are the author’s objectives? “Is a provide a huge amount of information, but it is highest percentage of users (72%) in the 18-29 age particular product being promoted? Does the important to be aware that: range. Women tend to use the internet seeking health site sell that product? Or is the information • Anyone can write or edit a Wikipedia article; related information more than men. It is estimated, publicly funded, non-commercial site such as there is no assurance that what is written is according to the PEW Center that 113 million people a government agency or research hospital?” accurate. per day use the internet. Jones says. • All Wikipedia authors are anonymous thus the • Detailed facts and resources: “The information credibility of the article based on the author’s “Searching online for symptoms and diagnosis can be provided on the website should be from a background can be verified. a frustrating, confusing, and very dangerous process,” credible source, such as a medical association, says Harlan Weinberg, author of Dr. Weinberg’s an accredited education institution, a Thus, Wikipedia articles should not be cited in Guide to the Best Resources on the Web. “That’s professional journal with an editorial board college research papers and information from articles why it’s important to have a discerning eye when or government agency. Look at other sites should always be verified from a second, reliable evaluating health websites. “Used properly, the on the same topic to see if the information source. Wikipedia should be a starting point for Internet can be a powerful tool to assist healthcare is confirmed elsewhere.” Some sites have research, not an end point. professionals in providing current, informed “Advisory Board” on the bottom of the page information to patients.” “An informed patient, who that lists those who provide and review When reviewing an article on the internet, many of wants to be involved in their own healthcare, can information on the site. Be sure the credentials the same questions can be asked as when evaluating make it easier to treat,” says Carolyn Clancy, former align with the website content. websites. director of the Agency for Healthcare Research and • Privacy protection: Health information should Quality (AHRQ). Given the numbers of individuals be confidential. Look for a privacy link at A few added points of assessment may include: utilizing on line resources, it is essential to have a the bottom of the page. Avoid the site if it • Viewing history: Look at when the article method of evaluating the legitimacy of websites. indicates they share information with other was created and how many edits and companies. changes occur overtime. The original intent of the article could be changed as a result of There are several ways to evaluate websites but continual revisions and changes. essentially they all advocate the same precautions. • Article quality: Is the writing clear without Ask yourself questions regarding, authorship, spelling errors and incorrect grammar? purpose, objectivity, accuracy, reliability and Are there citations or references with credibility, currency, and links. Links should be footnotes? Does the article clearly identify related to the topic, useful and purposeful to the site, topic, introduction, review of concept, and current, evaluated or annotated. Many colleges have summation? excellent resources on credibility and assessment of • Discussion: Review the article’s discussion websites including recommendations for research page to evaluate if there are questions (evidence based) information. You can also use the regarding validity of content and questions Better Business Bureau’s site to verify a website’s raised regarding information presented and legitimacy. consider if the topic is controversial. • Check the template at the top of the page Not everyone is a health expert on the Internet so for concerns regarding quality, references or having the tools to evaluate whether it’s a legitimate sources, unverified claims, etc. site for information can be useful. Dixie Jones of the Medical Library Association, offers these guidelines Using the Internet can be an enlightening experience with valuable links to nursing, medical, and other health related information to answer questions for nurses and their patients. As a tool using the Internet can assist you in providing quality care for your PSYCHIATRIC patients. APRN Anita Pavlidis, RN, MSN, was the former Director of Nursing at the NHTI, Concord’s Community College Seeking Psychiatric APRN - FT (35hrs) at The Mental Health It is useful to compile a few of your favorite websites and Program Specialist at the New Hampshire Board Center in Berlin, NH (prefer FT but PT possible; child/family for health information for your own use as a health of Nursing certification preferred). Integrated multidisciplinary clinical team. care provider and another list to provide to patients 100% outpatient; 90-min evals and 30-min med appts. Optional seeking legitimate health tips on the internet. Some References paid phone-only overnight/weekend call. Benefits include http://spryliving.com/articles/better-health-just-a-click- medical insurance, 403(b) with employer match, 11 paid holidays, websites can be useful for both health professionals and patients. Once you find your favorite web away-video/ generous vacation. Eligible for National Health Service Corps and https://outreach.wikimedia.org/wiki/Bookshelf State of NH Loan Repayment Programs. Must have current NH sites, most internet browsers will let you place a License, accredited training, and skills in community psychiatry. “bookmark” at each of these locations. You can then retrieve a list of these “markers” allowing you to go Please send CV and cover letter with salary requirements to Melissa Myers, MD, NHS, 25 W. Main St., Conway, NH 03818 or directly to the website. e-mail to [email protected].

Position requires a valid driver’s license, proof of adequate auto insurance and the completion of driving, criminal and background records checks. This Agency is an Equal Opportunity Employer, and Provider. April, May, June 2018 New Hampshire Nursing News • Page 13 Questions to Ask in Making the Decision to Accept a Staffing Assignment for Nurses

Reprinted with permission of the American Nurses Association If there are geographic difficulties, what resources are available to manage the situation? If my patients are on more than one unit and I must go to another unit to 1. What is the assignment? provide care, who will monitor patients out of my immediate attention? Clarify the assignment. Do not assume. Be certain that what you believe is the assignment is indeed correct. 6. Is this a temporary assignment? When other staff are located to assist, will I be relieved? If the assignment is temporary, 2. What are the characteristics of the patients being assigned? it may be possible to accept a difficult assignment, knowing that there will soon be Do not just respond to the number of patients; make a critical assessment of the reinforcements. Is there a pattern of short staffing, or is this truly an emergency? needs of each patient, his or her age, condition, other factors that contribute to special needs, and the resources available to meet those needs. Who else is on the 7. Is this a crisis or an ongoing staffing pattern? unit or within the facility that might be a resource for the assignment? Do nurses on If the assignment is being made because of an immediate need on the unit, a the unit have access to those resources? How stable are the patients, and for what crisis, the decision to accept the assignment may be based on that immediate period of time have they been stable? Do any patients have communication and/or physical limitations that will require accommodation and extra supervision during Questions to Ask continued on page 18 the shift? Will there be discharges to offset the load? If there are discharges, will there be admissions, which require extra time and energy?

3. Do I have the expertise to care for the patients? Am I familiar with caring for the types of patients assigned? If this is a “float Management Minute assignment,” am I crossed-trained to care for these patients? Is there a “buddy system” in place with staff who are familiar with the unit? If there is no cross- training or “buddy system,” has the patient load been modified accordingly? 10 Questions for 4. Do I have the experience and knowledge to manage the patients for whom I am being assigned care? If the answer to the question is “no,” you have an obligation to articulate limitations. Leaders Limitations in experience and knowledge may not require refusal of the assignment but rather an agreement -regarding supervision or a modification of the assignment By truthfully answering the questions below, leaders can increase to ensure patient safety. If no accommodation for limitations is considered, the awareness of behaviors that impede their abilities and make course corrections. nurse has an obligation to refuse an assignment for which she or he lacks education or experience. 1. Are you so entrenched in your perspective that you don’t hear what others are saying? 5. What is the geography of the assignment? Taking the time to consider other points of view not only creates an Am I being asked to care for patients who are in close proximity for efficient opportunity for you to share your views, but also helps you understand management, or are the patients at opposite ends of the hall or on different units? whether or not your ideas are sound.

2. Do you really listen when others are speaking? People can sense when you are not present in a conversation. Your lack of attention will likely be interpreted as a lack of respect or interest in what others *In the December 2017 meeting the have to offer. Board of Nursing waived the fee for any additional certification obtained by 3. Do you push too hard to get the thing that you want? licensed APRNs. Push creates pushback from others, which may turn into a competition to *For nurse educators who have not determine who is right and who is wrong. Emotions will likely take over, yet obtained a Master’s degree the leading to a downward spiral that will not end well. Board of Nursing clarified that the requirement for graduate program 4. Do you assume that you know better or that you are always right? matriculation requires documented News proof of course completion at the When the leader always has to be right, people tend to quit speaking up and end of every term. Non-master’s sharing their ideas. prepared nurses may hold temporary educator status provided they are “matriculated” in a degree 5. Do you allow your negative emotions to determine what you say, do or think in granting program. The clarification requires the nurse to be actively pursuing the moment? the degree each semester. If you allow your emotions to rule your behavior, they may be contributing to results you don’t wish to create.

Board of Nursing Practice Inquiries 6. Does your desire to play it safe or to be comfortably secure hinder your ability to be vulnerable and connect with others? Q: Can RN’s remove pleural catheters? BON: Yes, a RN can remove pleural catheters with documented training When frustrated with the direction that your supervisor or team seems to be and competency and a facility policy and procedure. headed, recognize that your feelings can serve as a wonderful cue that it is time to speak up. Q: With a provider order, is it within RN/LPN scope of practice to mix/draw up lidocaine, depomedrol or Marcaine for intra articular injector used by the 7. Do you avoid heartfelt expressions of appreciation or gratitude? provider? BON: Board it is within scope of RN/LPN to mix and draw up Acknowledging others for their contributions is one of the easiest ways to build medications, with a provider order and advises the following situations relationships and reinforce their positive efforts. for use: a. During an emergency situation in an operating room or treatment 8. Do you take the time to reflect and focus on what matters most? room- a nurse working in the same room, at the same time, Taking some quiet time to reflect on your thoughts and examine your behavior attending the same patient may collaboratively prepare an injection will allow you to assess if you are getting the results that you say you really for immediate patient administration. want. b. Communication between and the provider and nurse should occur regarding validation of the integrity of the medication, and dosing 9. Are you empathetic and understanding of others? as indicated by the medication order. c. Documentation should be completed in accordance with Everyone is rational from their point of view. Rather than assuming that people organizational policies. don’t know what they are doing or are deliberately making mistakes, slow down and ask more questions and really listen. Q: With a provider order, is it within the scope of practice of an RN/LPN to apply fluoride varnish to the teeth of a pediatric patient as part of the primary 10. Are you blind to your own behavior? care office visit? BON: Yes, it is within scope of RN/LPN to apply fluoride varnish to We communicate in many ways that have an impact on others: tone of teeth with a provider order and appropriate training and competency. voice, word choice, intensity, inflection, body language, emotions and communication style. Pay close attention to how others are responding to you: Q: Is it within the LNA scope of practice to place a Purwick External Catheter? do they move toward or away from you, seek you out or avoid you? BON: Yes, it is within an LNA scope of practice to place a Purwick External Catheter with appropriate training and competency. Adapted from “Are you getting in your own way? Get more of what you want and less of what you don’t” by John R. Stoker (2018). Page 14 • New Hampshire Nursing News April, May, June 2018 IN MEMORY OF OUR COLLEAGUES

The New Hampshire Nurses Association honors the Manchester Nurse from NHTI in Concord and retired from nursing in 1992 memory of and acknowledges the work of deceased Jacqueline Alice (Gregoire) Macrigeanis, after practicing at Lakes Region General Hospital and nurses who have graduated from New Hampshire 81, died November 10, 2017. A diploma Mease Hospital in Dunedin, Florida. nursing schools or who have actively practiced in New graduate in 1957 she received her Hampshire during their career. Sharing the names and bachelor’s degree from UNH and a School Nurse information about these nurses is one way we honor master’s degree in education from the their contribution to the profession. Brief submissions are Harvard Graduate School of Education. Barbara (Stewart) Cliff, 75, died welcome. She had also attended an Enterostomal November 20, 2017. Until her retirement, Therapy Program. Prior to retirement, she had practiced she was employed for over 30 years as a Portsmouth Nurse as a registered nurse at the Elliot Hospital and previously nurse for the Hooksett school district. Helen C. (Raikos) Kalantzakos, 87, at Catholic Medical Center as well as had her own passed away November 8, 2017.She independent nursing practice. attended the University of New Hitchcock LPN Hampshire and graduated from the LPN Educator School of Nursing at Lowell General Lucienne Bisson Royce, 91, passed away November 10, Hospital. She practiced at Portsmouth 2017, after a long battle with Alzheimer’s. She received Kathryn (Schoff) Maurer, 84, passed Regional Hospital. her LPN in 1945, her RN 1968 and her BS 1978. She away November 21, 2017. She was a practiced as a nurse at Brattleboro Memorial Hospital, private duty LPN at Dartmouth Hitchcock the Keene Clinic, and the Brattleboro Retreat and for Medical Center. Keene Grad many years at Thompson School for Practical Nursing, Olive M. (Estabrook) Fuller, 95, passed first as an instructor and later as the Nursing Director, away November 9, 2017. Graduating from retiring in 1987. New Grad nursing school in 1943 she practiced in Shea Black, 45, passed away private duty nursing for many years at Hitchcock Grad unexpectedly November 25, 2017. He Elliot Community Hospital in Keene, NH. Juanita “Nita” Crosby Choukas, 87, was a hairstylist for more than two She was also night supervisor of the passed away November 11, 2017. She decades and recently attended NHTI and Intensive Care Unit at Elliot Community, graduated from The Mary Hitchcock Lakes Region Community College, where and served as Head Nurse of the Recovery Room when Nursing School in 1951 and practiced as he graduated with an Associate of the hospital became Cheshire Medical and moved to its a surgical nurse for many years. She also Science in Nursing on May 12, 2017. new facility on Court Street. served as the head nurse during summer sessions of the Cardigan Mountain School Frisbie Nurse Ski Nurse from 1956-1960 Louise (Rousseau) Rutherford, 78, Betty (Roy) Hussey, 84, died November passed away November 9, 2017. The Littleton LPN 26, 2017. She practiced as an RN at youngest of 16 children, she practiced as Sharon Ellen (Cooney) Holbrook, 68, Frisbie Memorial Hospital for over 35 a registered nurses in variety of locations passed away on November 12, 2017. She years. and settings including being the nurse at was raised and educated in Berlin, and Loon Mountain Ski Area and attended the NH Technical Institute Hillsborough County Nursing Home. where she received her LPN in Nursing. She worked at Littleton Regional Hospital Concord Nurse as an LPN Debra Levins, 55, of Concord, passed Nurses are vital to Camp Robin Hood! Visiting Nurse away November 26, 2017. Earning a Camp Robin Hood is seeking qualified RNs & Nurse Karen L. (Johnson) Atwood, 70, died peacefully BSN in 1984 she practiced at Concord Practitioners to join us in Freedom, New Hampshire this November 17, 2017. Graduating from nursing school in Hospital for over 30 years. summer, 2018! 1968, she moved to Sunapee, NH in 1978 and practiced Camp Robin Hood is an overnight summer camp for around for the Newport Hospital briefly. From 1986 until her 350 boys and girls aged 7-16 years old . Our mission is to retirement in 2012 she was a registered nurse for Lake provide a nurturing environment in which lasting bonds are made . CMC Nurse Sunapee Region Visiting Nurse Association. Ann M. (Grondin) Blouin, 62, died December 4, 2017. We are looking for qualified individuals who are available to live at camp for the summer and must be willing to do on-call over night shifts . Room and board included . A Berlin native she graduated from the Catholic Medical NHTI Grad Center School of Nursing in Manchester in 1979. She Dates: June 18–August 10 (Dates are flexible) Dorothye (Smith) Wentworth, 84, passed away practiced as a Registered Nurse for over 30 years. Salary: Based on experience • Requirements: CPR/AED/First Aid November 19, 2017 after a lengthy illness. She graduated If interested please send a copy of your resume to [email protected] April, May, June 2018 New Hampshire Nursing News • Page 15 IN MEMORY OF OUR COLLEAGUES

School Nurse CNOR Her enlistment as an Army Nurse over the next 20 years, Marie Gemma R. Jean-King, 94, passed Carolyn Gayle (Small) Plummer, 61, died took Maureen to many Military Hospitals and Medical away December 7, 2017. An Epping December 27, 2017 after a courageous Centers around the U.S.A. and World caring for soldiers native she earned her nursing diploma battle with cancer. She practiced as a injured in Desert Storm and Persian Gulf Wars before from Sacred Heart Hospital in Registered Nurse for 40 years, a CNOR retiring as a Medical Corps Major. She then practiced as Manchester. She was a nurse at Exeter and a member of AORN. She was in the the surgical manager for the Monadnock Community High School and was the first nurse at the operating room at Wentworth Douglas Hospital in Peterborough. Lincoln Street Hospital for 25 years and most recently at School where she retired Concord Orthopaedic Surgery Center. She also held UNH Grad from in 1985. She was also other positions over her career including Sally L Orcutt (Glazier), 71, passed away January 12, President of the School school nurse in Somersworth, N.H., a nurse 2018. She attended the University of New Hampshire Nursing Association. at Camp Brookwoods in Alton, N.H., and and then spent much of her working life as a third shift roles in other surgery centers, doctors’ offices nurse treating patients with dementia, in a lock down Office Nurse and hospitals. Alzheimer’s care facility. Maxine Inga Paine-Fowler, 73, passed away December 8, 2017. After receiving ED Nurse Public Health Nurse an AD and BSN in nursing she relocated Rachel Louise (LaSalle) Bourque, 88, died December Sandra Lee “”Sandy”” (Whitcher) Hair, 75, died to New Hampshire and continued her 27, 2017. Rachel received her RN through Regis College January 21, 2018 after a long illness. She practiced for career in nursing at Strafford Medical and Carney Hospital and her BS in Nursing from St many years as a public health nurse for Grafton County Associates until she retired. Anselm’s College. She worked for many years as an ER and the Warren Elementary School. nurse at Memorial Hospital/SNHMC in Nashua. Sacred Heart Grad Childbirth Educator NH Hospital Grad Anne V. (Gildea) Abbott, 98, died Barbara J. Greenway, 87, January 22, 2018. She was a diploma died December 14, 2017. A Eleanor (Kenney) Tabor Corliss, 98, graduate of Sacred Heart Hospital School graduate of Boston University, passed away December 30, 2017. At age of Nursing and in her early years she was a member of the Nat. 58, she graduated from the NH Hospital practiced as a registered nurse at Sacred Honor Soc. of Nursing (Sigma School of Nursing, and practiced as a Heart Hospital. Theta Tau). She practiced in New Registered Nurse. Hampshire as a nationally accredited childbirth educator (ACCE). Berlin LPN Elliot Grad Ellen M. (MacDonald) Fecteau, 72, died January 22, Elliot Grad Evelyn C. (Main) Driscoll 92, died 2018. She was employed as an LPN in Berlin for 30-plus Evelyn (Gray) Reynolds, 74, died peacefully December 30, 2017 after a years. December 15, 2017. She received her RN long struggle with dementia. She degree from Elliot Community Hospital graduated from the Elliot Community Rehab Nurse School of Nursing in Keene. Her nursing Hospital School of Nursing in Keene as a career included the Elliot Community registered nurse in 1946. Joan Elizabeth Hauser, 58, passed away Hospital, Keene and the original Intensive on January 26, 2018. She practiced as an Care Unit at Mary Hitchcock Hospital. Army-Air Force Nurse RN most recently at Crotched Mountain Marguerite M. Laetsch Wurtz, 99, died Rehabilitation Center. Laconia Grad January 9, 2018. Born in Switzerland she Barbara L. (Willoughby) Berry, 92, immigrated to the United States in 1925. passed away December 16, 2017.She was After receiving her nursing diploma she Gero Nurse a graduate of the Laconia Hospital School joined the Army Nurse Corps from 1944 to 1947, then of Nursing Class of 1947. Prior to her joined the regular Air Force from 1948 until 1952. During retirement in 1987, she practiced as a WWII she held a prominent role in setting up a military Gail D. (Wesner) Cote, 78, died January registered nurse in the Maternity Ward at hospital in Paris, operated behind the lines during the 28, 2018 after a period of failing health. Concord Hospital. Battle of the Bulge, and served as an interpreter due to She retired from McKerley Nursing Home her fluency in multiple languages. After relocating to where she practiced as a registered nurse. Army Nurse Corp Warner she practiced as the school nurse for Kearsarge Lillian Louise (Luby) Morris, Regional High School and Simonds Elementary School 99, passed away December from 1966 to 1981. St. A’s Grad 16, 2017, after a short illness. Dorene F. (Wells) Young, 68, passed A Massachusetts General Army Nurse Corps away February 2, 2018. She earned her Hospital School of Nursing graduate and Maureen Mullins, Maj, USA Bachelor’s Degree in Nursing from St. while employed there in 1942, she rushed (ret), 73, passed away Anselm College. She practiced in to the hospital one night while off-duty to January 11, 2018 following a Massachusetts and after moving back to help care for the more than 400 victims of the Cocoanut period of declining health. New Hampshire in 1985, she worked for Grove nightclub fire, the deadliest nightclub fire in After obtaining her nursing diploma she Intracorp and later co-operated Medi- history. Lillian enlisted in the Army Nurse Corp. during enlisted in the U.S. Army Medical Corps STRAT, which investigated medical insurance fraud (work World War II and served overseas in England and as a second Lieutenant Registered Nurse. that she always said made her feel like Quincy, M.E.). France. After the war she relocated to Berlin where she was an occupational health nurse at Granite State Rubber Company, later known as Converse.

Salter LPN Stephanie Elizabeth Trombly, 28, passed away December 24, after a twelve year battle with Ewing Sarcoma. She attended Psst... Do You Want To Make the University of New England, Biddeford, Maine, and earned her degree A Difference in 2018? from the Salter School of Nursing. As an Break Away From The Herd! LPN, Stephanie cared diligently and tenderly for residents of the Merrimack County Nursing Be Heard • Be Valued • Be Empowered Home where she had been employed for the past two RiverWoods is HIRING—RN/LPN/LNA years. RiverWoods Exeter, a Continuing Care Retirement Community is seeking WDH Nurse highly motivated health care Katherine Leone (Colbath) Towle, died on December 26, 2017. A 1954 diploma graduate she practiced as an professionals to join our team! RN at Wentworth Douglass Hospital for 31 years, where www.RiverWoodsrc.org she was a beloved night supervisor. [email protected] Call Barbara at 603-658-1541 Page 16 • New Hampshire Nursing News April, May, June 2018

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Notify the physician if the • Maybe if we tell people the brain is an app, the NCLEX (AKA “Boards”), how well would you do now? urine changes color they’ll start using it. • Don’t know where your kids are in the house? 1. During a minor cosmetic surgery the nurse monitors 4. In caring for a patient with Turn off the internet and they’ll show up the conscious sedation during which fentanyl and Bell’s Palsy what interventions quickly. midazolam were administered. If the midazolam dose are appropriate? (Select all that • Never trust someone who takes hours to text has been excessive, what findings would you expect? apply) you back, but when you hang out with them (Select all that apply) a. Order a full liquid diet they check their phone every minute. a. Patient will begin gagging on the oral airway b. Provide eye protection at • Sunglasses: allowing you to stare at people b. Patient will begin moaning for pain medication night without getting caught. It’s like Facebook in c. Patient will not respond to verbal commands c. Administer pain real life. d. Patient’s blood pressure will be elevated from medication on a set • My cell phone is acting up, I keep pressing the baseline schedule home button but when I look around, I’m still e. Patient’s oxygen saturation will be less than 94% d. Use a picture board to at work. assist in communication • Common sense is like deodorant, those who 2. What is the correct interpretation of the 6 second e. Seek speech therapy consult need it the most never use it. rhythm strip? 5. The healthcare provider is assessing a pregnant woman during her first prenatal visit. The patient reports she has a 5-year-old at home who was delivered at 39 weeks gestation. Her last pregnancy a. Normal sinus rhythm ended at 12 weeks gestation due to a spontaneous b. Sinus tachycardia abortion. She delivered a set of twins at 22 weeks c. ST segment elevation gestation. The twins died within 12 hours of birth. d. First degree heart block How is the woman’s obstetrical history documented using the GTPAL system? 3. When teaching a client about Pyridium a. G4 T1 P1 A1 L1 (phenazopyridine), an antispasmodic, what should the b. G3 T2 P2 A0 L2 nurse included in the teaching plan? c. G5 T2 P1 A0 L3 a. Take the drug as ordered for 7 days d. G4 T1 P2 A1 L1 b. Take the drug until pain relieved c. Take the drug after intercourse Answers can be found on page 19

That research paper isn’t going to write itself. Visit www.nursingALD.com to gain access to 1200+ issues of official state nurses publications, all to make your research easier! April, May, June 2018 New Hampshire Nursing News • Page 17 When Compassionate Care Takes a Turn Toward Fatigue

Jennifer Flynn & Mary M. Gullatte RN • “When I make a mistake, I have difficulty stressors at home from childcare or aging parent care forgiving myself.” all play a role. Some studies show that “helpers,” such Fatigue, emotional distress, or apathy resulting from the • “My achievements define my self-worth.” as nurses, are more vulnerable to life changes such as constant demands of caring for others: today’s nurses • “I take work home frequently.” divorce and difficulties such as addictions than people are facing new levels of compassion fatigue. Empathetic, • “I am willing to sacrifice my needs in order to who do less stressful work. Workplace stressors such as passionate, and caring nurses can fall victim to the please others.” managing paperwork, new technology or organizational continual stress of meeting the needs of not only their realignment can also play a role. patients but their families as well. This can pose serious Not to be confused with “burn out”, where a nurse safety concerns on two sides of the spectrum. It can may gradually withdraw and step away from his or her Although nurses are accountable for their individual lead to errors and issues in patient care, and overall work, a nurse with compassion fatigue may try even practice, employers also have a responsibility to help nurse burnout can drive more skilled nurses out of the harder and give even more of themselves to patients in identify and address sources of compassion fatigue in the profession. their care. Both scenarios can leave nurses feeling like workplace. Designing schedules and organizing work they are running on empty, putting themselves, their co- can be key strategies to help prevent the consequences According to the American Association of Colleges workers, the public, and their patients at risk. of nurse fatigue, but early identification of compassion of Nursing, 13 percent of newly licensed RNs were fatigue demands understanding and ongoing assessment. working in a different career within one year of their The Consequences of Compassion Fatigue The Professional Quality of Life Scale (ProQOL) can help licensing, and 37 percent indicated they were ready to Nurses have a responsibility to themselves and their measure these symptoms and be used regularly to track change jobs. Lack of staffing, trouble with management patients to ensure they’re adequately supported to changes over time, particularly when a nurse is trying or salary issues aren’t the only things pushing nurses provide the highest quality and compassionate care prevention or intervention strategies. from the bedside. Significant, ongoing emotional stress is possible. Facing multiple workplace stressors, coupled a key contributor that can often go ignored. with the demands to respond to complicated patient Long-Term Solutions needs as well as their home life, can negatively impact Compassion fatigue and its negative impact on nurses, Defining the Issue a nurse’s ability to cope with stress to the detriment of patient satisfaction and safety is slowly becoming a Multiple terms have been used to describe compassion overall patient and nurse safety. better understood phenomenon in the nursing field. fatigue, but in its simplest terms, compassion fatigue Acknowledging the severe emotional impact of a nurse’s implies a state of psychic exhaustion where caregivers The consequences of such involved, caring work can obligation to routinely meet a patient’s immediate face severe sense of malaise that results from caring for lead to: and comprehensive needs, nurses are in need of more patients who are in distress over time. Traumatology • Inability to react sympathetically to a crisis or specialized support resources to counter the impact. expert and senior faculty at the Figley Institute, Dr. disaster because of overexposure to previous These can and should involve programming designed Charles Figley calls this phenomenon the “cost of caring” crises and disasters. to educate nurses about the issue, resources to manage for others in emotional pain. • Extreme states of tension and preoccupation with work/life balance and efforts to design supportive and the suffering of those being helped to the degree positive work settings. While all health care providers are subject to compassion that it can be traumatizing for the helper. fatigue, nurses are particularly vulnerable because • Cynicism, emotional exhaustion or self- Promoting self-care and other healthy rituals is important they are inserted in the lives of others in an intimate centeredness in a healthcare professional who for preventing or recovering from compassion fatigue. way during a critical time in that individual’s life. They has been otherwise dedicated to his or her work Encourage nurses to participate in activities that can become partners instead of observers in a patient’s and clients. promote physical, emotional and spiritual well-being. journey and are pulled into existential concerns of life, Nurses should also be encouraged to seek out support death, sadness and loss. In this regard, compassion This emotional exhaustion also can cause breakdowns in the form of Employee Assistance Programs (EAPs), fatigue could be considered an occupational hazard. in communication and build stress that leads to errors by caregiver or nursing support groups, or other forms of Statistics Canada’s first ever National Survey of the Work the nurse, which pose safety risk and liability. According counseling and emotional support. Remember that self- and Health of Nurses (2005) found that “close to one- to the CNA AND NSO Nurse 2015 Claim Report, care always includes adequate nutrition, hydration, sleep fifth of nurses reported that their mental health had made allegations against nurses involving assessment and and exercise. their workload difficult to handle during the previous monitoring represent 15.7 percent and 13.8 percent of month.” In the year before the survey, more than 50 total claims, respectively. Compared to the previous data The responsibility to solve for these risks relies with the percent of nurses said they had taken time off work set, both allegations categories increased by 3.1 percent healthcare industry as a whole, as well as management because of a physical illness, and 10 percent had been and 7.0 percent, respectively. Most of the assessment- and nurses in the field to foster the environment and away for mental health reasons. related closed claims involved a failure to assess the demand the resources necessary to overcome the issue. need for medical intervention where the nurse failed to Dennis Portnoy, a licensed psychotherapist who contact the treating practitioner for additional medical Jennifer Flynn, CPHRM, is Risk Manager for Nurses specializes in topics such as professional burnout and treatment. Over half the monitoring-related claims Service Organization in the Healthcare division of Affinity compassion fatigue, created a self-assessment tool involved failure to monitor/report changes in the patient’s Insurance Services, Inc. specializing in risk management. that caregiving professionals can use to recognize condition to the practitioner. attitudes and habits that perpetuate compassion fatigue. Mary M. Gullatte, PhD, RN, ANP-BC, AOCN, FAAN, According to Portnoy, nurses who are experiencing Compassion fatigue expert Francoise Mathieu writes is the Corporate Director of Nursing Innovation and compassion fatigue tend to identify very strongly with that many factors outside of a nurse’s core care-giving Research for Emory Healthcare and the former Vice statements such as: work also contribute to the continuum of compassion President of Patient Services and Chief Nursing Officer at • “People rely on me for support.” fatigue. Current life circumstance, coping style and Emory University Hospital Midtown.

Are you ready to advance in Nursing Practice? Check out your options right here at UNH:

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For more information about UNH Nursing www.chhs.unh.edu/nursing Page 18 • New Hampshire Nursing News April, May, June 2018 When the Thrill is Gone

Reprinted from Colorado Nurse, to make assumptions, not to take anything personally, May, June, July 2017 issue things do not always go according to plan, and to give up being concerned with being in control of what I am like by becoming curious about what I will be like. “We Burn your dream bright. rarely offer ourselves the time and space to consider: Am Strategies to Pursue it with the best of who I doing what I most want to be doing with my life? Do I Recover from Burnout you are. But don’t confuse even know what this is? Nhat Hanh writes, The noise in hustle with burnout. Hustle our heads and all around us drowns out the ‘still, small • Take a break and get help fills you up. Burnout empties voice’ inside. We are so busy doing ‘something’ that we • Identify and grieve your losses you. Hustle renews your rarely take a moment to look deeply and check in with • Confront denial and cynicism energy. Burnout drains it. ~ our deepest desires.”4 • Acknowledge one’s limitations Jon Acuff Holistic nurses reflect on action to become aware • Establish personal boundaries of values, feelings, perceptions, and judgments that • Nurture oneself Burnout is nature’s way of may affect actions, and they also reflect on their • Learn and use stress-reducing actions telling you, you’ve been experiences to obtain insights for future practice. They • Employ problem-solving strategies to going through the motions value themselves and mobilize the necessary resources prevent future burnout. your soul has departed; to care for themselves. They endeavor to integrate self- Priscilla Smith- you’re a zombie, a member awareness, self-care, and self-healing into their lives Source: Trudeau of the walking dead, a by incorporating practices such as self-assessment, Hamilton, P. M., & Ness, S. M. (2015). Burnout: Coping sleepwalker. False optimism is like administrating meditation, yoga, good nutrition, energy therapies, with job-related stress in healthcare. Retrieved 1 December 22, 2016, from http://www.nursingceu. stimulants to an exhausted nervous system. Healthcare movement, creative endeavors, support and lifelong com/courses/494/index_nceu.html professionals are challenged on a daily basis with a learning.5 variety of stressors as they care for patients. These job- related stresses can take a toll on the mind and body Finding Balance of these professionals, which in turn may affect the So to succeed in life at the personal level as well as quality of patient care and outcomes. Work-related professional level and even in your social circles, one has stress may also impact job satisfaction, workforce to maintain a delicate balance between what your heart 2 stability, and safety in the healthcare environment. says and what your head dictates. When the thrill is gone our spirit needs nourishment Work stress in nursing was first assessed in 1960 when ~ Commander Veerendra Jaitly, We Can! We Can! and care. Burkhardt and Nagai-Jacobson (2016) offer Menzies identified four sources of anxiety among nurses; that a way that nurses care for and nurture themselves patient care, decision-making, taking responsibility, Burnout is a personal journey and there is no one influences their ability to function effectively in a and change. The nurse’s role has long been regarded size fits all approach to recovery. My years of nursing healing role with another. Care of their spirit or soul as stress-filled based upon the physical labor, human have taught me that there is a place at the center of requires nurses to pause to reflect on and absorb what suffering, work hours, staffing and interpersonal our being where we all know who we are, where we 3 is happening within and around them; to take time for relationships that are central to the work nurses do. know undeniably that we are whole and complete themselves, for relationships, and for other things that and that we need both balance and imbalance. One animate them; and to be mindful about nourishing their Self-Care and Self-Reflection cannot recognize balance without spirits. The many ways nurses nurture their spirits and Caring for myself is not self- recognizing imbalance. When we Burnout is a major issue for those in respond to their spiritual concerns are the same as those indulgence, It is self-preservation. ~ strive for balance, we need to be that they suggest to their patients.8 Turn your mind to Audre Lorde Taken from A Burst of the healthcare professions and can gentle and forgiving of ourselves. lead to: beauty, love and gratitude. These are your spirit’s three Light The truth of the matter is that we nutritional requirements. Make a commitment to the can’t do it all. Trying to do it all is health of your spirit. Take time to nurture it. See how Ten years into my career it became • Depression & physical illness a set-up for a 24-hour guilt cycle. • Low morale every day that you feed it, you find that much more glaringly apparent that the thrill Instead of continually feeling guilty to give it the next day. Feel the power of your spirit was gone. I loved the work, but • Feelings of incompetence & and stressed in your quest for hopelessness embracing all that life offers. Watch it soar as your life I had come to the point where balance, turn your attention toward turns toward a future of peace, fulfillment, and joy.9 I was mentally, physically and • Bitterness & anger doing the very best you can do • Difficulties in one’s home life 6 When the symptoms of an oncoming burnout start emotionally exhausted. Hanging every day with the time you have. surfacing, take the proactive approach. Purposefully out with friends, eating healthy • Absenteeism & staff turnover Dr. Wayne Dyer in his book, • Substance abuse disconnect, refresh then recalibrate. food, taking long walks just wasn’t Wisdom of the Ages (1998) asserts ~ Amber De La Garza, Productivity Specialist solving the problem. Seeking that highly productive people Source: www.ahna.org a fresh unbiased perspective, have a great sense of balance and Whenever I am feeling that the thrill is gone and a I sought the help of a health harmony in their lives. They are sense of “drift” has started to settle in, I remember the psychologist. He was very patient thoroughly familiar with pacing words of Ilan Shamir, who said, Carve your own path, with me for about two weeks as I vented all the reasons and knowing when to retreat and clear their heads of go slow, channel your strengths, smooth the way for why I felt the way I did. He decided it was time to jolt the immediate concerns. To avoid being consumed by others, keep moving forward, avoid meltdowns, swim me into change. He said, “We can sit here for a very anything you must be able to walk away from it. In the the current, stay calm under pressure and Be Cool! long time talking about why you feel the way you do, or process of walking away, you begin to see your work, we can sit here and talk about how you can start solving or family or a project from a perspective that appears 7 Priscilla Smith-Trudeau MSM RN BSN CRRN CCM your problems.” I sat back and thought, Aha, he wants smaller. HNB-BC is an author, speaker and healthcare me to get out of my head and get into my heart and management consultant. She is board certified in soul. When the counseling was over I had learned a new The Essence of Spirituality holistic nursing and rehabilitation nursing with a focus way of going about my life personally and professionally. In the unlikely event of a loss of cabin pressure, please on integrative health. Holistic nursing is at the core of There were many lessons the most important being not put on your oxygen mask first before assisting others. her nursing practice, self-care and consulting.

(Endnotes) 1. Keen, S. (1991). Fire in the belly: On being a man. New Questions to Ask continued from page 13 identify what would constitute bad faith. For example, York: Bantam Books. if you had not taken care of pediatric patients since 2. Van Bogaert P, Kowalski C, Weeks SM, Van heusden need. However, if the staffing pattern is an ongoing nursing school and you were asked to take charge D, & Clarke SP. (2013). The relationship between nurse problem, the nurse has the obligation to identify of a pediatric unit, unless this were an extreme practice environment, nurse work characteristics, emergency, such as a disaster (in which case you burnout and job outcome and quality of nursing care: a unmet standards of care that are occurring as a result cross-sectional survey. International Journal of Nursing of ongoing staffing inadequacies. This may result in a would need to let people know your limitations, but Studies, 50, 16 67–77. request for “safe harbor” and/or peer review. you might still be the best person, given all factors 3. Menzies IEP. Nurses under stress. Internatl Nurs Rev. for the assignment), it would be bad faith to take 1960;7:9–16 Retrieved October 24, 2016 from: https:// 8. Can I take the assignment in good faith? the assignment. It is always your responsibility to www.ncbi.nlm.nih.gov/books/NBK2668/ If not you will need to get the assignment modified articulate your limitations and to get an adjustment 4. Hanh, N., & Kotler, A. (1991). Peace is every step: The or refuse the assignment. Consult your individual to the assignment that acknowledges the limitations path of mindfulness in everyday life. New York, NY: state’s nursing practice act regarding clarification you have articulated. Good faith acceptance of the Bantam Books. 5. of accepting an assignment in good faith. In assignment means that you are concerned about Dossey, B. M., Keegan, L., & Barrere, C. (2016). Holistic understanding good faith, it is sometimes easier to the situation and believe that a different pattern of nursing: A handbook for practice (6th ed., p. 66). care or -policy should be considered. However, you Burlington, MA: Jones & Bartlett Learning. 6. Smith-Trudeau, P., (2014), Nurses finding work-life acknowledge the difference of opinion on the subject balance, Vermont Nurse Connection Vol , Vol 17 (3), 3 between you and your supervisor and are willing to 7. Dyer, W. W. (1998). Wisdom of the ages: A modern take the assignment and await the judgment of other master brings eternal truths into everyday life. New York: peers and supervisors. HarperCollins. 8. Burkhardt, M. A., & Nagai-Jacobson, M. (2016). Retrieved from American Nurses Association: Spiritualty and health. In Holistic nursing: A handbook http://www.nursingworld.org/mainmenucategories/ for practice (7th ed., p. 145). Burlington, MA: Jones & Bartlett Learning. thepracticeofprofessionalnursing/workforce/workforce- 9. advocacy/questions-in-decision-to-accept-staffing- Retrieved November 25, 2016 from: http://www. assignment.html bodymindspiritonline.com/bodymindspirit/edition21/12_ article_scott-3.htm April, May, June 2018 New Hampshire Nursing News • Page 19 WELCOME NEW and RETURNING NHNA MEMBERS!

NHNA welcomes these new and returning members. Thank you!!!

NHNA welcomes these new and returning members. Thank you!!! What do these 65 nurses know that you don’t? If you are not a member ask someone on this list why they joined! Go to nhnurses.org where joining is easy and one of the best professional values for your money! We want to see your name here in the next issue of the NH Nursing NEWS!

Samantha Arnold Dover Marie Ford Hudson Jamie Paterson Nashua Stephanie Ballentine Nashua Angela Franklin Center Barnstead Jasmine Plaisted Manchester Cymande Baxter-Rogers Sandwich Jennifer Freeman Milford Theresa Powell Amherst Sabrina Bolianites Merrimack Mark Gagne Hudson Jeanette Roy Manchester Erinn Boulay Goffstown Katie Glasheen Milford Darlene Sampson Derry Taylor Bourassa Newfields Tracy Hardy Merrimack Christine Shorey Durham Kelly Britton Manchester Ashley Hart Manchester Katelyn Siede Rochester Michelle Buck Littleton Karen Hunt Allenstown Linda Skidmore Chichester Barbara Carroll New London Lydia Huston Meredith Justin Smith Portsmouth Lisa Cassidy Milford Mikayla Johnston Chester Brenda Spencer North Sutton Jenny Cates Nashua Dorothy Jordan Salem Susan Thibodeau Weare Amy Chaisson Newton Rebecca Kelly Merrimack Kristine Thomas Hudson Erika Corbett Atkinson Ian Kirit Grantham Kathleen Thompson Manchester Brianna Defilippis Newport Sara Leonhard Derry Kelly Trask Belmont Pamela Deres Concord Karrie Lovejoy Hillsborough Kristina Tynes Kingston Lynne Duhaime Manchester Rosemary Mason-Blau Hudson Magdelina Vasquez Larkin Nashua Jessica Duplin Lebanon Cynthia Mathews Campton Donna Verville Fremont Frankie Eldredge Derry Michael McLaughlin Bow Lisa Vogan Nashua Jennifer Finn Goffstown Candace McWhirter Newfields Chandler Wallisch Amherst Mary Fisher Manchester Heather Newfield Randolph Jaimie Walton Meredith Jennifer Fitzgerald Nashua Gladys Ntabo Manchester Donna Woods Amherst Erin Foley Bow Jessica Nuttall Nashua

HELP, It’s an Emergency!

Reprinted from Arizona Nurse, How are you doing? Are you average, above average, whether you buy out or bring it with you, on May, June, July 2017 issue or in trouble? Is the amount you calculated for an average, brown bag lunches save $6.35 a day. emergency fund too darn big to contemplate? Start That’s $127 a month! A 2016 report from www. with a $1,000 goal. If you need to start or pad that • Cut back on unnecessary frivolous spending. Do Bankrate.com stated that emergency fund, here are some tried and true ideas you really need to stop for that skinny vanilla over 66 million Americans to help. latte? Are you eating out, not for enjoyment, but have no emergency • Treat the building of an emergency fund like a because you are just too tired to cook? There savings. None, zip, nada. bill. Contribute to it every month. are whole books and websites to help you make An emergency fund is • Use a budget. If you don’t have a budget, get on food shopping more efficient and meal planning defined as enough liquid line and find the many helps there are to create a and preparation more fun with less expensive, cash to cover routine living budget. healthier meals for yourself and your family. Make expenses. Most financial • Save money on food by using the store’s loyalty eating out a planned treat. advisors recommend a card. If you don’t like carrying around a card, minimum 3 month fund. most stores allow you to use a phone number. Whatever strategy you decide to use, be sure to Some advise at least a 7 Several stores also offer discounts on gas for start that emergency fund on the best day possible, month fund. According using their loyalty cards. Look at unit price to today! to the Bureau of Labor Shawn Harrell, determine which packaging or sale price is Statistics, www.bls.gov, the MS, RN better. Sometimes the results will surprise you. average annual hourly rate Take your lunch to work. Just that alone could for an RN in Arizona was $34.51 in 2015, the last year start an emergency fund. Trent Hamm of The Answers to NCLEX Reconsidered from page 16 of complete data. With the help of easily available Simple Dollar, www.thesimpledollar.com, did 1. c, e 2. a 3. b 4. b, e 5. d websites and my crude calculations, I figured the some pretty impressive home grown research average Arizona nurse, single and not a home owner, and concluded that while lunch costs something brings home about $50,790 after taxes a year. That hypothetical nurse should have around $12,500 saved in an emergency fund, very liquid and able to be accessed any time without penalties.

To determine your after tax monthly income, your pay stub is the best place to start. Remember, in case of an emergency, you would not be making contributions to 401K plans or other automatic routine savings plans. However, you would want to have health insurance, especially if the cause of the emergency were due to illness, so count those dollars as after tax income. Now multiply that amount by 3 to determine the minimum amount you 100 Saint Anselm Drive should have in an emergency fund. Manchester, NH 03102 Ok, that’s one way to figure what you need for an (603) 641-7086 emergency fund. Another way is to add up your monthly expenses. That should be easy if you are www.anselm.edu/cne working from a budget. If not, go back through the last 2 or 3 months’ expenses. Remember, you are looking for monthly necessities. If you lost your Committed to Promoting Excellence job you wouldn’t be taking a vacation, buying new in the Practice of Nursing clothes, or spending money on entertainment. You’re looking at rent/mortgage, insurance, car expenses, utilities, food, healthcare expenses, and consumer credit bills. You may be able to negotiate Online programs now available. consumer credit or school loan bills for lower monthly payments, but for planning, consider them a bill due. Take the monthly total of these expenses and multiple by 3. Remember, 3 months is the absolute minimum you need.