The Official Publication of the Utah Nurses Association

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Many Roles. One Pr UTAH NURSE

Volume 27 • Number 1 February, March, April 2018 Quarter ly public ation di rect mai led to ap proxima tely 33, 000 RNs a nd LPNs i Inside n Utah.

Highlights from our Annual Advocacy Preparation Day & University of Utah College of Nursing Annual Conference 2017 Distinguished Alumni 2017 Kathleen Kaufman, MS, RN, BC

The UNA was honored to Truth accompanies her love, nominate Kathleen Kaufman, MS, hand-in-hand. The care she has RN, BC for the University of Utah for patients drove her tough-love Distinguished Alumni Award. of students and personal care Those of us fortunate to work of her patients. This truth drives with her in the UNA, are a small her tireless advocacy today for representation of the patients, the nursing profession and all colleagues, students, citizens and citizens of Utah. She does not shy legislators that have had their lives away from critical, controversial, impacted by her remarkable spirit. conversations or subjects in Her life path took her from a pursuit of things she loves. All in family of 10 siblings on a farm the state of Utah benefit daily from in Pennsylvania, to a degree legislation and policies she has in Chemistry then a career in fought for. nursing, where she has served Her mentorship, advocacy and and led for a lifetime. moxie have made in indelible mark Two outstanding characteristics on generations of Utahns past and drive her advocacy, mentorship generations to come. and service are love and truth. This link provides a full read on She truly loved her patients by her bio for this award and her lifetime taking time to stop and listen and accomplishments. http://nursing. hear. She truly loved her students utah.edu/blog/2017/10/kaufman- with a tough love demanding distinguished-alum.php excellence. She continues to love the citizens of Utah through continued, tireless advocacy at the Page 9 state level. www.utnurse.org

Attention UNA Nurses’ Day at the Legislature Please join us Friday, February 9th for Nurses’ Day at the Legislature in Salt Lake City. Members We will begin in the Governor’s Hall in the Capitol at 8 AM, with a continental breakfast You can now find us on Facebook. Just search Utah and the program will begin at 9 AM. Breakfast will be $5.00. It will be a great opportunity Nurses Association and look for the page with the to learn about this year’s bills. We welcome all nurses and nursing students to attend. UNA logo. We will be posting updates for upcoming Your Government Relations Committee members have been following legislation events and information on conventions in our blog. proposed during the interim session since last spring.

Presort Standard 3 President’s Message 9 Highlights from our Annual Advocacy US Postage PAID 3 From the Editor Preparation Day & Annual Permit #14 4 The Shoulders We Stand On: Conference 2017 Princeton, MN 55371 A Day in the Lives 10 Nurses on the National Front current resident or 4 In Memoriam 11 Utah Decides Healthcare 5 From the Membership Committee 12 Introducing your newest UNA 6 Zero Suicide in Utah Board Members A Movement Towards Safer 13 How You Can Reduce Opioid Deaths Content Suicide Care in Healthcare Systems 14 Career Sphere 8 GRC Committee News 15 Utah Nurses Foundation Utah Nurse • Page 2 February, March, April 2018

PUBLICATION 2018 BOARD OF DIRECTORS INTERNET President Aimee McLean, BSN, RN, CCHP First Vice President Donner Schweitzer, BSN, RN NURSING Second Vice President Claire LeAnn Schupbach, BSN, RN, CPC, CHP UTAH NURSES Secretary Heather Lowe, BSN, BS, RN Treasurer Tracy Schaffer, MSN, RN The Utah Nurse Publication Schedule for 2018 ASSOCIATION receives its Internet services due to a generous Directors Sharon K. Dingman, DNP, RN Blaine Winters, DNP, ACNP-BC Issue Material Due to UNA Office grant from XMission, Utah’s largest and best local Director-at-Large Jason M. Martinez, BSN, RN May/June/ March 8, 2018 Internet Service Provider. For more information on July 2018 XMission’s services and pricing visit XMission on Guidelines for Article Development the Web at www.xmission.com or call 801-539- STAFF MEMBERS 0852. The UNA welcomes articles for publication. There is Office Manager Open Position no payment for articles published in the Utah Nurse. Executive Assistant Kaitlin McLean 1. Articles should be Microsoft Word using a 12 point Please visit the Utah Nurses Office Assistant Tori Schaffer Lobbyist Justin Stewart font. Association’s Web Page! Editor Claire LeAnn Schupbach, BSN, RN, CPC, CHP 2. Article length should not exceed five (5) pages 8 x 11 utnurse.org 3. All references should be cited at the end of the COMMITTEE article. Visit our site regularly for the most current updates 4. Articles (if possible) should be submitted and information on UNA activities. You can CHAIRS & LIAISONS electronically. obtain a listing of Continuing Education Modules By-Laws Open - If interested please email resume to UNA available through UNA or a listing of seminars and Finance Tracy Schaffer, MSN, RN Submissions should be sent to: [email protected] or conferences that offer CE credits. Government Relations CJ Ewell, MS, APRN-BC and Attn: Editorial Committee | Utah Nurses Association Diane Forster Burke, MS, RN 4505 S. Wasatch Blvd., Suite 330B Kathleen Kaufman, MS, RN, BC Salt Lake City, UT 84124 | Phone: 801-272-4510 Membership Sharon K. Dingman, DNP, RN Nominating Monte Roberts DNP, RN Janelle Macintosh, PhD, RN Lauren Clark, RN, PhD Education Committee Blaine Winters, DNP, ACNP-BC UTAH NURSES FOUNDATION Become a Nurse Peer Reviewer President Marianne Craven, PhD, RN Aimee McLean, BSN, RN, CCHP Looking for a flexible schedule volunteer opportunity • Interested in joining a unique group of nurse peers to serve your nursing association and your nursing supporting providing ANCC accredited continuing ANA MEMBERSHIP community? education for the nurses in your community? Become a Nurse Peer Reviewer — Supporting • A nurse planner for education programs and events ASSEMBLY REPRESENTATIVES Quality Continuing Education or a primary nurse planner of an Approved Provider Aimee McLean, BSN, RN, CCHP The Western Multi-State Division (WMSD) and its unit who wants to stay current in your knowledge Barbara Wilson, PhD, RNC four member associations — AzNA, CNA, INA, and of ANCC accreditation criteria? UNA invite qualified nurses to serve as peer reviewers • Willing to serve on the volunteer review panel or as PRODUCTION to evaluate continuing education programs for approval. an independent reviewer? Publisher Arthur L. Davis Publishing Agency, Inc. Their expertise supports continuing education activities • Qualified with a background in education, training, for the nurses in our four state division and beyond. and or relevant knowledge and experience in Editor and Publisher are not responsible nor liable for editorial The WMSD Accredited Approver Unit will provide educating nurses that would prepare you to or news content. training to all qualified Nurse Peer Reviewers to educate participate in the peer review process them on the ANCC/WMSD accreditation criteria. • Proficient in Microsoft Office suite, and accessing Utah Nurse is published four times a year, February, May, Are you: email and email attachments August, November, for the Utah Nurses Association, a • A currently licensed RN with a Bachelors Degree in If so, learn more about the selection and training constituent member of the American Nurses Association. Utah Nursing or higher? process at utnurse.org/education under the Nurse Peer Nurse provides a forum for members to express their opinions. Reviewers tab. Views expressed are the responsibility of the authors and are not necessarily those of the members of the UNA.

Articles and letters for publication are welcomed by the Published by: editorial committee. UNA Editorial Committee reserves the utnurse.org right to accept of reject articles, advertisements, editorials, and Arthur L. Davis letters for the Utah Nurse. The editorial committee reserves Publishing Agency, Inc. the right to edit articles, editorials, and letters.

Address editorial comments and inquiries to the following address: Utah Nurses Association, Attn: Editorial Committee 4505 S. Wasatch Blvd., Suite 330B Salt Lake City, UT 84124 [email protected], 801-272-4510

No parts of this publication may be reproduced without permission. Subscription to Utah Nurse is included with membership to the Utah Nurses Association. Complementary copies are sent to all registered nurses in Utah. Subscriptions available to non- nurse or nurses outside Utah for $25. Circulation 33,000. All address changes should be directed to DOPL at (801) 530- 6628. 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, sales@aldpub. com. UNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.

Acceptance of advertising does not imply endorsement or approval by the Utah Nurses Association of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. UNA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of UNA or those of the national or local associations. February, March, April 2018 Utah Nurse • Page 3 Empowering Patients to Manage Pain PRESIDENT’S MESSAGE Dawn Johnson, PT, DPT, CSCS

Pain has easily become one of the most controversial and prominent topics in medicine today. Historical trends Aimee McLean BSN, RN, CCHP member, I encourage you to were to ensure more than adequate treatment of all pain join now at the extraordinary for all patients. Over the decades, research and policies Welcome to a new year! I hope everyone who set low rate. It is a pilot project have swung in full reverse and current movements goals for this year is off to a good start. If you haven’t so we do not know how long are aimed at restricting opioid prescriptions to the yet signed up for the national Healthy Nurse Healthy it will continue. Get in now extent, that some legislators are defining prescription Nation campaign, I encourage you to do that now. Being while you can secure that parameters. Despite these drastic steps, there are simple healthy doesn’t end with last year’s Year of the Healthy low rate. For our premier techniques to keep in mind that have been shown to Nurse initiative. We still want everyone to put caring for members, ANA continues reduce pain beyond the use of narcotic pain medications. themselves mentally as well as physically as a major to expand the perks and One such technique is a corner stone of physical priority in their life. We all know too well that nurses tend privileges associated with to put everyone else first and neglect their own care. premier membership. As therapy’s rich history for treating pain: educating Aimee McLean patients. Teaching patients instills empowerment, builds I am excited to tell you that this year our organization always, we encourage each trust and reduces fear-avoidance beliefs.1 will be undergoing some changes. We will be launching and every one of you to get Essential topics relevant for all health care workers a new website with some member only features. We will involved. We know everyone feels like they don’t have the include the origin of the pain, anatomy relating to the also launch some member only initiatives through our time, but this is our organization, this is our state, and it is condition or procedure, tissue healing timeframes membership committee. We will work to grow our Phone our country. Even adding your thought to a Governmental and their link to post-operative protocols, prognosis 2 Action outreach and we are already off to a great start Affairs issue once or twice a year is a great contribution. and its relationship to the anatomy and physiology, planning this year’s two-day annual conference. We Join a committee; we welcome your viewpoints! Have a and imperatively, about pain itself. Explaining specific continue to participate in the pilot project with ANA that great end of winter and beginning of spring! neuroanatomy and function including the brain’s allows our great new reduced pricing. If you are not a perception of pain, neuroplasticity and sensitization has been shown to improve outcomes in reported pain severity, physical disability, catastrophizing and activity tolerance. Given the shared pathways of pain with cognition and emotion, acute or chronic pain has the possibility of being modified with a simple conversation.2 Keep an anatomy book near by, give links for reputable FROM THE EDITOR websites, use an app on your phone or use models to unveil the medical mystery creating anxiety in our patients. Education should also extend to the numerous Claire L Schupbach BSN, RN, CPC, CHP In consideration of intangible elements, which may affect chronic pain advocacy, reviewing the or vice versa, such as mental health.3,4 Illumination of Our view, 2018, a new year. Welcome. Our first past and the work it takes to these should go hand-in-hand with recommendations edition of the new year focuses on where we have come move forward one can easily for improvements of mental health as medical practice from, where we are going and the cross-professional note these accomplishments reduces the chemical control of pain. There needs to collaboration it takes to make that happen. The were not completed through be an increase in awareness and use of mental Government Relations Committee (GRC) has provided singular effort. Professional health treatments for pain such as counseling, extensive updates of the bills to be vetted in the 2018 and cross-professional meditation, prayer, tai chi, or cognitive behavioral Utah Legislative Session. These bills directly impact collaboration have a rich therapy5.1,6 Current research demonstrates benefits the future of our profession and the future health of history within the nursing from alternative treatment options, but more research is the citizens of Utah. We look forward to your input and profession, which must needed.7, 8 involvement through attendance at the annual Nurses’ continue to meet the As medical practitioners, we should take the time to Day at the Legislature. Our organization looks to the challenges of the future. To Claire L. Schupbach ensure our patients have as much understanding of future as we introduce two new board members gifting that end, we have an article their condition as is possible. Medicine today puts more us with their fresh energy and enthusiasm. In support of on Zero Suicide by Andrea Hood, MS and an article on emphasis on efficiency and reimbursement, and is also your career development, we have continued our series Empowering Patients to Manage Pain by Dawn Johnson, up against practitioner shortages. Despite the current of articles on serving on boards. As we look to ground PT, DPT, CSCS. Suicide, pain management and the opioid model, a few minutes of education can increase the ourselves we peek into the lives of two colleagues from epidemic touch our patients’ lives and our lives’, and, can quality of care, improve outcomes and demonstrate Utah’s past and their impact on the health of our state be intertwined. These experts provide additional resources compassion. Allow patients the opportunity today in our Day in the Life column. In alignment with to the options and treatments we can offer our patients. of knowledge. In return, we will become better the ANA’s 2018 theme of Advocacy, we review the As we face the future we acknowledge we stand practitioners; more versed in our content area and highlights of the UNA’s Annual Advocacy Preparation on the shoulders of those who have gone before us, strengthen the relationship between practitioner and Conference & Annual Conference in October of 2017. advocated on behalf of our profession and the health of patient. We encourage you to take time to read the information Utah citizens and collaborated wherever required. We say regarding the Medicaid Ballot Initiative. This is a “Thank you.” 1. George S, Fritz J, Bialosky J, Donald D. The effect of great opportunity to advocate, if you have that as a a fear-avoidance–based physical therapy intervention professional goal for 2018. for patients with acute low back pain: results of a randomized clinical trial. Spine. 2003; 28(23): 2551- 2560. 2. Russek L, McManus C. A practical guide to integrating behavioral and psychologically informed approaches into physical therapist management of patients with chronic pain. Orthopaedic Practice. 2015; 27(1): 8-16. PN RN 3. Demyttenaere K, Bruffaerts R, Lee S. Mental disorders among persons with chronic back or neck PROGRAM pain: Results from the world mental health surveys. Ephraim & Richfield Campuses Pain. 2007; 129(3): 332-342. 4. Edlund M, Martin B, Devries A, Fan M, Braden J, Sullivan M. Trends in use of opioids for chronic non- cancer pain among individuals with mental health and LPN substance use disorders: the TROUP study. Clin J Pain. 2010; 26(1): 1-8. PROGRAM 5. van Tulder M, Ostelo R, Vlaeyen J, Linton S, Morley Ephraim, Nephi & S, Assendelft W. Behavioral treatment for chronic low Richfield Campuses back pain: a systematic review within the framework of the Cochrane back review group. Spine. 2000; 25(20): 2688-2699. Affordable housing 6. Veehof M, Oskam M, Schreurs K, b, Bohlmeijer E. and tuition assistance is Acceptance-based interventions for the treatment of available. chronic pain: A systematic review and meta-analysis. Pain. 2010; 152(3): 533-542. 7. Chiesa A, Serretti A. mindfulness-based interventions for chronic pain: a systematic review of the evidence. Contact us today for more details! The Journal of Alternative and Complementary Medicine. 2011; 17(1): 83-93. Melissa Blackner: 435-893-2232 8. Hall A, Maher C, Latimer J, Ferreira M. The Or Amber Epling: 435-893-2228 effectiveness of Tai Chi for chronic musculoskeletal [email protected] pain conditions: A systematic review and meta- analysis. Arthritis & Rheumatism. 2009; 61(6): 717–724. www.snow.edu/alliedhealth Utah Nurse • Page 4 February, March, April 2018 The Shoulders We Stand On: A Day in the Lives

The Shoulders Kyle Cannon BSN, RN Margaret “Peggy” We Stand On Oct 20, 1958 - Oct 30, 2013 Eklund, MS, BSN, RN

By Claire L Schupbach, BSN, RN, CPC, CHP Diane Forster Burke, MS, RN Oct 10, 1934 - Jan 26, 2014

We are taking a departure from our usual Day in the Kyle worked for the Salt Lake Valley Health Diane Forster Burke, MS, RN Life column to look back and honor our colleagues who Department and in his last years before his retirement, came before us here in Utah. Ordinary people, who he was the Nursing Supervisor in the Communicable Peggy graduated from Judge High School and later worked tirelessly to care for their patients and move the Disease Bureau. He had been diagnosed with Multiple graduated from Holy Cross School of Nursing in 1955. nursing profession forward in our state. They cared for Sclerosis and worked for many years despite this She received a B.S. in Nursing from St. Mary’s College their patients, raised families, went to school and worked disability. He had great skill with maneuvering his electric in Notre Dame, Indiana and a M.S. in Public Health in their communities. We are gifted with sight, inspiration, wheelchair. He earned two Bachelor’s Degrees from the Administration from BYU. During her long career, she foundation, wisdom and encouragement when we pause U of Utah, including his nursing degree in 1991. taught at St. Mark’s School of Nursing and then worked to look back. One colleague noted he was relentless in tracking in the Communicable Disease Bureau at the Salt Lake down homeless patients with TB. Kyle was very Valley Health Department, eventually becoming the knowledgeable in all things Communicable Diseases. Nursing Supervisor of this bureau. He was a “level-headed and fair supervisor, and In 1994 she was awarded the “Public Health Nurse of demonstrated exceptional courage and dedication the Year” Award by the Utah Public Health Association. working well into the advanced stages of MS. He Peggy was the 3rd recipient of this award. reluctantly retired only when he became truly unable to Peggy was a member of Saint Ambrose Parish, where tolerate what surely was an intolerable physical, cognitive she served as an Eucharistic minister, Candle minister, and and emotional challenge.” she was a member of Daughter of Utah Pioneers. She was Another colleague reported that “Kyle loved teaching a member of the PEO Chapter AC. She had a great love of Public Health concepts, especially about communicable animals, especially dachshunds, and her “Hunter.” diseases, to student nurses at Westminster College, A colleague remembers Peggy telling of a time when and they loved to listen to his stories. He always arrived she had to go out of state (Colorado) to pick up a person on time, enduring tremendous physical challenges just with active TB and bring the patient back to SLC. She to get there. Kyle always held their attention with his accepted the possibility of exposing herself to this practical advice, kindness and with stories of his vast disease, but knew the importance of bringing him to Salt experiences.” Lake. It was winter, and she drove back with the windows He was a gentle and kind man; involved in many down to get him back to Salt Lake. She was a true Public community activities. He gave freely of his time and Health nurse!! She was very practical with that “You just expertise. have to do it!” attitude. He remained cheerful and caring to his family (wife Another colleague recalls when there was a reportable Julie, 3 children, and 1 grandson). He continued to be disease for which there was a vaccine, Peggy would deeply committed to public health throughout his career. go into the neighborhood armed with vaccines and Immune Globulin ready to take care of anyone who In 2010, the Institute of Medicine released a would hold still. She loved teaching nursing students by landmark report, The Future of Nursing: Leading sharing stories of diseases that we once thought were Change, Advancing Health, which recommended eradicated. She would be very upset today by declining increasing the number of nurse leaders in immunization rates in some school children. She had pivotal decision-making roles on boards and seen what these diseases did to children and knew that they must be prevented. commissions that work to improve the health of everyone in America. The Nurses on Boards Coalition (NOBC) was created in response to this, as a way to help recruit and engage nurses to step into leadership roles. The NOBC represents nursing and other organizations working to build healthier IN MEMORIAM communities in America by increasing nurses’ presence on corporate, health-related, and other boards, panels, and commissions. The coalition’s goal is to help ensure that at least Dolleen Jewett passed away October 07, 2017. Geraldine Golden Winters passed away October 10,000 nurses are on boards by 2020, as well At the start of World War II she entered nurse’s training 16, 2017. She loved being of service to others which as raise awareness that all boards would benefit spending three years at the St. Marks School of Nursing. led her to pursue a degree in nursing. She enjoyed her employment at Cottonwood Hospital and the Holladay from the unique perspective of nurses to achieve After graduating in 1944 she joined the Army Nurse Clinic with Dr. Burt Green and Dr. William McCaa before the goals of improved health in the United States. Corps. The European conflict was ending, so she was sent to the Naval Hospital in Oakland, California retiring at the age of 67. We encourage each and every one of to care for the many injured sailors and Marines from Fay Keune passed away August 29th 2017. She you, over 3 million strong, to visit www. the Pacific Theater. Her nursing career lasted a lifetime received her nursing degree from the University of nursesonboardscoalition.org, sign up to be until her retirement in 1987. She gained a wide variety Montana. Fay worked in California & Hawaii in her early of experiences, including in Public Health for Salt Lake counted if you are on a board and read more years, then settled in SLC. She worked for PCMC, the County. She went back to school earning a four-year about the efforts being made to help build the University of Utah, and the Utah Department of Health. future of our profession. degree with a B.S. in Nursing from the University of Utah. She became the Director of Nursing for the Davis Lauren Aquino passed away October 24, 2017. County Health Department in 1965, a position she held She successfully attended Weber State University and for 21 years. She started the Women Infant Children obtained her Associate’s degree in nursing. She touched (WIC) program, supervised school nurses, immunization many patients’ lives while working as a nurse at LDS and well-child clinics and established the first home-care hospital on the surgical and orthopedic units. Most agency in Davis County. recently, Lauren was employed as a nurse at the Breast Cancer Clinic at the Huntsman Cancer Institute.

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Martha Wilks Harrison See www.BrighamHypnosis.com and call 435-720-1678 There is NO better time than now to become independent! February, March, April 2018 Utah Nurse • Page 5 FROM THE MEMBERSHIP COMMITTEE Sharon K. Dingman, DNP, MS, RN – Membership Committee Chair

UNA joins with ANA in informing our members and prospective members about the valuable professional information available to all registered nurses in Utah. Membership information is found in the ANA Member Guide Information folder [(©AHA, 2014 ANA-BRO6 (6/16)]. We encourage you to renew your membership at: http://www. nursingworld.org/joinana.aspx. Benefits for ANA/UNA members includes access to professional tools you will use in your professional life, including access to research tools, nursing resources, etc. You can access these resources through your MyANA Sharon K. Dingman account at NursingWorld.org/MyANA. Being a member of ANA/UNA makes a powerful statement about you and your commitment to nursing. Membership provides a way for nurses across the United States and Utah to speak with one strong voice on behalf of nursing and our patients. Continuing education and member programs provide you access to learning opportunities to keep you up-to-date in nursing knowledge and advance your career. Additionally, you will find information about personal health and healthy work environments that are safe, empowering, and satisfying. As a member, you can stay up-to-date through journals and publications: American Nurse Today (monthly journal); The American Nurse: ANA’s official newspaper, The Online Journal of Issues in Nursing (OJIN) by using your member login at Nursing World.org/OJIN, E-Newsletters: ANA SmartBrief, ANA Nurse CarrerBrief, Nursing Insider, and Member News. Network and connect through social media with your state and national association by visiting the UNA website to learn more---http://www.utnurse.org. For additional local information contact [email protected]

IMPORTANT CONTACTS AT-A-GLANCE

ANA Member Services: 1-800-923-7709 - FAX: 1-301-628-5355 Mail: American Nurses Association 8515 Georgia Avenue, Suite 400, Silver Spring, MD 20910

Update Your Profile: NursingWorld.org/MyANA

ANA E-mail Addresses: • Membership: [email protected] • American Nurses Foundation (ANF): [email protected] • ANA-PAC: [email protected] • NursesBooks.org: [email protected] • Ethics Issues: [email protected] • Lobbying — Federal and State: [email protected] • Meetings and Conferences: [email protected]

Look up your state nurses association’s contact Information by going to NursingWorld.org Professional Development and Networking Resources Online: • ANA Career Center: NursesCareerCenter.org • ANA Leadership Institute: ANA-LeadershipInstitute.org • ANCC Certifications: NurseCredentialing.org • Book Discounts: NursesBooks.org • Online Continuing Education: ANANurseCE.org • Navigate Nursing: NavigateNursing.org

American Nurses Credentialing Center: 1-800-284-CERT (2378) A Voice for Nursing

UNA leaders represent your interests in a wide variety of meetings, coalitions, conferences and work groups throughout the year, anticipating and responding to the issues the membership has identified as priorities. In addition to many meetings with legislators, regulators, policy makers and leaders of other health care and nursing organizations, the following is a partial list of the many places and meetings where you were represented during the past three months....

• UNA Board Meeting • Health and Human Services Interim Committee of Utah State Legislature • Utah Nursing Consortium • UNA 2017 Conference • UNA Annual Advocacy Day • State Board of Nursing • Western MSD Webinar Committee Meetings • Falls Prevention Task Force • Association for Utah Community Health Conference • Utah State Board of Nursing • ANA Advocacy Institute Workshop, Washington, D.C. • Academic Leadership Council of UONL • Utah Health Policy Project Fall Summit • University of Utah College of Nursing Distinguished Alumni & Young Alumni 2017 Award Ceremony Utah Nurse • Page 6 February, March, April 2018 Zero Suicide in Utah A Movement Towards Safer Suicide Care in Healthcare Systems

Andrea Hood, MS outpatient mental health referrals. I would argue that Safety Planning Zero Suicide Project Coordinator these are not healthcare provider failings, or patient Utah Department of Human Services failings. These are system failings. There is a solution. If suicide risk is not imminent, a safety plan must be developed before the patient is referred to outpatient Human life has value. Even when mistakes have Zero Suicide- A Quality Improvement Solution care. In years past, when a provider discovered that a been made, even when great suffering is present, there patient was having suicide ideation they would often have is a possibility for meaning, for healing, for redemption. To address these challenges, the Utah Division of them sign a no suicide contract, e.g., “I, ______, As healthcare workers, as healers in our community, Substance Abuse and Mental Health, and recently promise to give treatment a chance and not to end my these are likely beliefs that you hold close. Intermountain Healthcare, have adopted the Zero life, especially until I see my doctor again in two weeks.” While we may individually hold these beliefs in Suicide framework, from the Suicide Prevention Suicidologists have found that patients often see these personal and profound ways, do our systems of Resource Center. The foundational belief of Zero contracts as an unhelpful effort to limit provider liability. care reflect these values? More specifically, do our Suicide is that suicide deaths for individuals under In a report in 2009, the Substance Abuse and Mental healthcare systems make every effort to create safety care within health and behavioral health systems Health Administration has advised that these contracts nets for the patient at risk of ending their own life by are largely preventable. It presents both a bold are not recommended and never sufficient (SAMHSA, suicide? goal and an aspirational challenge. The programmatic 2009). They are no longer an acceptable standard People having thoughts of suicide often experience approach of Zero Suicide is based on the realization of care or effective in reducing provider liability. profound ambivalence and a significant part of them that suicidal individuals often fall through the cracks One reason they are ineffective is because they describe does not want to die, they simply cannot see another in a sometimes fragmented and distracted health care to a patient what NOT to do in crisis, rather than helping solution to end their emotional and physical pain. When system. Zero Suicide provides a systematic approach them come up with alternatives of what might be helpful they are supported through the suicidal crisis and we to quality improvement in these settings, with a wealth in a crisis to help them feel better and stay alive. A treat their pain effectively, most people at risk can of practical recommendations and resources. collaborative and comprehensive safety plan provides be reconnected with their reasons for living and will The Zero Suicide framework includes specific exactly those alternatives. not go on to die by suicide. A life worth living can be strategies in each of these core components: engaging This brief intervention is well documented in its created and a tragic outcome avoided, if suicide risk leadership, training care providers, identifying those effectiveness, and if done well it can significantly reduce is detected, assessed, carefully and empathetically at risk, engaging at-risk individuals in treatment, the likelihood of a patient suicide attempt several months managed, and effectively treated. providing suicide specific treatments, facilitating safe after it is administered (Bryan et al, 2017). There are even transitions in care, and consistently evaluating and digital Apps such as MY3 so the patient can carry their Suicide Risk at Your Work Place improving processes (http://zerosuicide.sprc.org/). The safety plan with them at all times. The essential elements strategies are based on the “Perfect Depression Care” of a safety plan include helping the patient identify the One in fifteen adults in Utah experiences thoughts of model developed by the Henry Ford Health System following: suicide in any given year; and chronic pain and illness in Michigan. This model successfully reduced • Warning signs (thoughts, situations, emotions, substantially increase the risk of suicidal thoughts and the patient suicide rate by about 80%, from 89 behavior) that a crisis may be developing behaviors, so it is likely that you interact with patients per 100,000, to 9 consecutive quarters without any • Coping strategies they can use on their own on a weekly or even daily basis with some level of suicides (Hampton, 2010). This success proved that • People and social settings that can provide healthy suicide ideation (SAMHSA National Survey on Drug Use suicide is indeed preventable when the appropriate distraction and Health, 2008-2009). strategies and investments are put in place. • People they can go to for help during a crisis The first challenge in care is that many individuals It is worth looking at a few of these strategies in a • Emergency contacts at risk are never identified. If healthcare systems lack little more depth, to see how simple systems changes • Safety precautions such as limiting access to a screening system for depression and suicide, up can make profound differences to patient well-being firearms and medications to half of those at risk, are likely to slip through the and mortality. Hopefully these strategies will help • Reasons for living cracks, according to one emergency department study to debunk ineffective traditional practices (such as (Boudreaux et al, 2015). contracting for safety) and empower you with simple A safety plan is designed to empower the When we are able to accurately identify who is at and effective tools in working with patients at risk. person to manage their own suicidal thoughts risk, it is often difficult to know how to engage with without acting on them, and can help prevent suicide them on the topic of suicide. Given the complexity, Universal Screening behaviors and avoid unnecessary hospitalization. high-stakes, and taboo nature of these interactions, However, most patients also require outpatient behavioral it is not surprising the majority of Utah’s health and It was already noted that half of all suicidal patients health treatment to address the factors that contribute behavioral healthcare workers feel they do not have the are likely to be missed without the use of universal to ongoing suicide risk, i.e., mental health conditions, skills or training needed to engage those with suicidal screening tools (Boudreaux et al, 2015). Research trauma, or maladaptive coping patterns and cognitions. desire or intent, according to the 2013 Behavioral also finds that 75% of patients with clinical depression Health Workforce Survey (Division of Substance Abuse present to primary care with physical symptoms only: Counseling on Access to Lethal Means and Mental Health). Unfortunately, the healthcare sleep disturbances, pain, appetite changes, etc. (Tylee setting has become a crucial missed opportunity for & Gandhi, 2005). Patients often won’t speak up; we An essential part of safety planning is limiting access intervention, illustrated by the fact that an average of must initiate the discussion. In Utah, many providers to means that a patient could use to take their life, 45% of suicide decedents were seen by their primary are using the PHQ-9 and the Columbia Suicide Severity particularly firearms and medications. A common suicide care provider within one month prior to their death Rating Scale to identify more people at risk and triage prevention myth is that if someone is “determined” to (Luoma, Martin, and Pearson, 2002). Even patients them to appropriate treatment. These tools are free take their life that they will find a means to do so, so identified as having suicide risk often fall through the to use, and online training is available on the C-SSRS attempting to restrict access to means is ineffective. Let’s cracks; with the majority never following through on website (http://cssrs.columbia.edu/). It is important explore why this perception is incorrect. to distinguish that the purpose of screening and First, most suicidal people experience strong assessment is not to predict suicide (which ambivalence about suicide, so buying them time during would be nearly impossible) but to plan for a crisis could give them a chance to de-escalate and appropriate treatment and care. If the screen is thus delay or prevent a suicide attempt. Additionally, positive, a full risk assessment is completed by the while the distress, ambivalence, and underlying risk provider or a social worker. A full risk assessment can be present for years, many attempts themselves includes a series of questions intended to gather more are impulsive and occur with little to no planning during detailed information about severity of ideation, level of a short-term crisis (Hawton, 2007). In two different planning, access to means, history of suicide behavior, studies, nearly half of attempt survivors said less than 20 impulsivity, mental health status, social supports, minutes passed between the time they decided to take their life and when they attempted suicide (Simon et al, TOHONO O’ODHAM NATION HEALTHCARE coping skills, reasons for living, etc. Several models for this are available including the decision support 2001; Deisenhammer et al 2009). Finally, the means tool from SPRC and the SAFE-T TOOL available online one uses drives the lethality of the attempt, and people IS NOW RECRUITING! http://www.sprc.org/sites/default/files/EDGuide_ with a stronger suicide intent do not necessarily use more lethal means- in many cases the means SELLS HOSPITAL – SELLS, AZ: quickversion.pdf. chosen is more closely connected with availability • Practical Nurse • Nurse Practitioner than level of suicide intent (Eddelston, 2006; Swahn • Nurse Specialist/Case Manager • Public Health Nurse 2001). The conclusion is that reducing access to lethal • Clinical Nurse/Emergency Care • Clinical Nurse/ means is an evidence based strategy that may delay or • Medical Instrument Technician Ambulatory Care prevent an attempt, or at least reduce the lethality of an • Medical Laboratory Technician The Utah attempt. Department of Corrections To reduce access to lethal means, it is critical to SAN XAVIER CLINIC – TUCSON, AZ IS HIRING! • Nurse Specialist/Case Manager involve family members in the conversation and safety plan development. Even if the patient’s risk of • Lead Clinical Nurse/Ambulatory Care Come work in a dynamic • Medical Instrument Technician suicide is fairly low (a wish to die only, but no plan), environment as part of a it is wise to create a safety plan and discuss how SAN SIMON CLINIC – SAN SIMON, AZ (NEAR AJO, AZ) multidisciplinary, collaborative team! to reduce access to firearms and medications, as • Nurse Specialist/Case Manager Current openings: suicide risk can fluctuate quickly. The best action • Supervisory Clinical Nurse/Ambulatory Registered Nurses, Licensed Clinical would be to temporarily remove firearms from the home, but additional locks or safeguards can be put in place For more information, contact Melissa Pablo at: Therapists, Physician’s Assistants, Nurse Practitioners, Psychologists, and Physicians. if that is not an option. A free online course is available 520-383-6540 or [email protected] to learn more about how to have conversations about You may also visit our website: We offer a competitive compensation and benefits reducing access to lethal means (https://www.sprc.org/ http://tonation-nsn.gov Follow the “Employment” link and package, with paid holidays, vacations, sick leave, resources-programs/calm-counseling-access-lethal- click on “Healthcare Opportunities” health insurance and retirement. means). Ask us about our competitive benefits! SEE STATEJOBS.UTAH.GOV February, March, April 2018 Utah Nurse • Page 7 Direct Treatment of Suicidal Ideation suicide risk. We invite you to join in the movement to reform your care of suicidal patients, as individual Once the patient is assessed and the safety plan providers and as agencies. With the right strategies has been established, the patient must be referred for and investments, these deaths of despair can be ongoing care. It was previously thought if you treated prevented by a responsive, informed, and empathic When to Ask About underlying mental health conditions the suicide ideation safety net of care. would resolve on its own, as distressing thoughts and Suicidal Thoughts emotions were reduced. While this is true for some 1. Substance Abuse and Mental Health Services people, the Suicide Prevention Resource Center now Administration National Survey on Drug Use and advises clinicians to treat suicide risk directly in a Health, 2008-2009 Andrea Hood, MS therapeutic setting. One evidence-based model for this 2. BourdreauX ED, Carmargo CA Jr, Aria SA, Sullivan type of treatment, is the Collaborative Assessment and AF, Allen MH, Goldstein AB, Manton AP, Espinola It may be appropriate to ask about suicidal Management of Suicidality (CAMS), which provides a JA, Miller IW. Improving suicide risk screening and thoughts or conduct a screening if any of the model for clinicians to focus treatment around patient- detection in the emergency department. American following warning signs are observed: defined “suicidal drivers” (Ellis et al, 2012). Journal of Preventative Medicine. 2016; 50 (4), 445- • Talking about death or a wish to die, or 453. doi: 10.1016/j.amepre.2015.09.029. https://www. threatening suicide Referrals and Transitions in Care ncbi.nlm.nih.gov/pubmed/26654691 • Expressing hopelessness: “nothing is going to 3. Division of Substance Abuse and Mental Health. Utah get better, why should I bother?” Referrals to outpatient mental health treatment are Behavioral Health Workforce Survey. 2013. • Expressing burdensomeness: “my family one example of a transition in care. Transitions in care 4. Luoma JB, Martin CE, Pearson JL. Contact with would be better off without me” are a particularly high risk time for patients, especially mental health and primary care providers before • Expressing desperation or despair: “I just can’t when patients are released from inpatient settings, suicide: a review of the evidence. American Journal of take it anymore” and it is crucial to take measures to ensure a smooth Psychiatry. 2002; 159 (6), 909-916. https://www.ncbi. • Putting affairs in order: life insurance, living will, transition and prevent patients from falling through the nlm.nih.gov/pubmed/12042175 saying thank you or goodbye cracks during this time (Appleby Et al, 1999; Qin & 5. Hampton T. Depression care effort brings dramatic • Sudden, unexplained euphoria or calm after a drop in large HMO population’s suicide rate. Nordentoft, 2005). As many as 70% of suicide attempt period of distress JAMA. 2010; 303 (19), 1903-1905. Doi: 10.1001/ survivors never attend their first outpatient appointment jama.2010.595. http://jamanetwork.com/journals/ • Obtaining access to lethal means or maintain treatment for more than a few sessions jama/fullarticle/185885 • Alcohol, drug or medication abuse (Appleby et al, 1999; Boyer et al, 2000). It is easy for 6. Tylee A, Gandhi P. The importance of somatic • Withdrawal/social isolation patients to get lost. They may never connect with the symptoms in depression in primary care. Primary • Reckless behavior new provider, lose contact with the referring provider, Care Companion to The Journal of Clinical Psychiatry. • Any patient presenting for a mental health and/or no-show for an appointment never receiving a 2005; 7 (4), 167–176. condition, such as depression, severe anxiety, follow up. This is simply not acceptable for a patient 7. Substance Abuse and Mental Health Administration. bipolar disorder, psychosis, or post-traumatic stress with suicide risk. Integrated care is now the healthcare Addressing Suicidal Thoughts and Behaviors • Patients who are undergoing stressful life industry gold standard where social workers are in Substance Abuse Treatment; a Treatment circumstances could be at increased risk, available to provide assessment and brief treatment Improvement Protocol. 2009. https://store.samhsa. especially if the previously mentioned warning on site to patients; however, this is not available in all gov/shin/content/SMA09-4381/TIP50.pdf signs are observed in addition to any of the settings. To appropriately manage patients at risk 8. Bryan CJ, Mintz J, Clemans TA, Leeson B, Burch following: unemployment, divorce, chronic of suicide during referral and care transitions, the TS, Williams SR, Maney E, Rudd D. Effect of crisis pain, insomnia, facing a life altering diagnosis following strategies are recommended: response planning vs contracts for safety on suicide like cancer/HIV/Alzheimer’s, failing in school, • Establish agreements in advance with outpatient risk in U.S. Army soldiers: A randomized clinical trial. loss of a close family member or friend, victim treatment providers to facilitate rapid referrals Journal of Affective Disorders. 2017; 212, 64-72. Doi: of abuse, etc. (24-48 hrs) for higher risk patients or after 10.1016/j.jad.2017.01.028. inpatient discharge 9. Hawton K. Restricting access to methods of suicide. How to Ask About Suicidal Thoughts: • Revise the patient’s safety plan before discharge Crisis. 2007; 28 (S1), 4-9. 10. Simon TR, Swann AC, Powell KE, Potter LB, Kresnow or referral Asking directly about suicide in an open, non- M, O’Carroll PW. Characteristics of impulsive suicide • Ensure the patient has spoken by phone with the attempts and attempters. SLTB. 2001: 32 (supp), 49- judgmental manner is the best way to get an honest new provider or a crisis worker 59. response. For example: • Send patient records several days in advance of 11. Deisenhammer EA, Ing CM, Strauss R, et al. The • “Sometimes people who are experiencing the appointment to the new treatment provider duration of the suicidal process: how much time chronic pain start to feel hopeless that their • Call the new provider to review patient is left for intervention between consideration and situation will improve and may even have information before the first appointment accomplishment of a suicide attempt? Journal of thoughts of suicide. Have you had any suicidal • Contact the patient within 24–48 hours after they Clinical Psychiatry. 2009: 70 (1), 19-24. thoughts?” have transitioned to the next care provider and 12. Eddleston M, Karumaratne A, Weerakoon M, • “You mentioned that your depression causes document the contact Kumarasinghe S, Rajapakshe M, Sheriff MH, Buckley you to feel very sad and hopeless. How sad do • Flag no-shows and take action to locate the NA, Gunnell D. Choice of poison for intentional self- you get? Do you ever feel so bad that you have person, ensure their safety, and reschedule the poisoning in rural Sri Lanka. Clinical Toxicology. 2006; thoughts of ending your life?” appointment or link them to a higher level of care 44 (3), 283-286. if necessary 13. Swahn MH, Potter LB. Factors associated with the For more information or for opportunities • Follow up with caring contacts over the next medical severity of suicide attempts in youths and to practice this skill, please request a suicide few months after discharge or referral–such young adults. Suicide and Life-Threatening Behavior. prevention training at https://utahsuicideprevention. as postcards or phone calls to check in on the 2001; (32), 21-29. org/education-training. patient and remind them of resources, if needed 14. Ellis TE, Green KL, Allen JG, Jobes DA, Nadorff (http://zerosuicide.sprc.org/toolkit/transition). MR. Collaborative Assessment and Management of Suicidality in an inpatient setting: Results of a pilot Conclusion study. Psychotherapy (Chicago, Ill). 2012; 49 (1), 72- 80. Doi: 10.1037/a0026746. These strategies will help ensure no patient falls 15. Appleby L, Shaw J, Amos T, McDonnell R, Harris C, through the cracks and there is “no wrong door” to McKann K, Parsons R. Suicide within 12 months of seeking help for thoughts of suicide. Written policies contact with mental health services: National clinical and regular staff training on components of these survey. British Medical Journal. 1999; 318, 1235-1239. Join Our Experienced, strategies are crucial to make these changes 16. Qin P, Nordentoft M. Suicide risk in relation to part of your organizational culture and increase psychiatric hospitalization. Archives of General CLOSE-KNIT TEAM! provider competence in managing suicide risk. Psychiatry. 2005; 62, 427-432. Hopefully the powerful and well-researched 17. Boyer CA, McAlpine DD, Pottick KJ, Olfson M. strategies described here, while not an exhaustive Identifying risk factors and key strategies in linkage to outpatient psychiatric care. American Journal of list, can add tools to your repertoire of patient care. If Psychiatry. 2000; 157, 1592-1598. Doi: 10.1176/appi. these strategies have only piqued your curiosity ajp.157.10.1592 and you want more technical assistance and training, please email [email protected]. More resources can also be found at zerosuicide.com or, if you are looking for webinars or strategies specifically for an emergency department, at http://www.sprc. org/settings/emergency-departments. As a state, we Casa Real Nursing & Rehabilitation Center is a trusted are at a tipping point for improving the quality of care name in our community, with staff members that have of patients experiencing mental health conditions and worked here over 20 years, and we want YOU to be a part of our team! Do you have a passion for working with those who need compassionate 24-hour nursing care? We offer specialized training and advancement opportunities for health care professionals who are: • Registered Nurses • Licenced Practical Nurses • Licenced Vocational Nurses • Certified Nurses Aides

Sign-on bonuses available for full-time positions: • RN: $10,000 • LPN/LVN: $7,500 • CNA: $3,000 1650 Galisteo Street, If you would like to become part Santa Fe, NM 87505 PHONE: 505-984-8313 of our interdisciplinary team, CasaRealNursing.com please contact us today! [email protected] Utah Nurse • Page 8 February, March, April 2018 GRC COMMITTEE NEWS

Kathleen Kaufman, MS, RN, BC, Donner Schweitzer and Kathleen Kaufman employer changes insurers.). Diane Forster-Burke, MS, RN, & represented UNA at the American Nurses Advocacy Clean Air Bills The current bill is HB134S02 CJ Ewell, MS, APRN-BC, GRC Co-Chairs Institute workshop in Washington DC where the many Emissions Testing Amendments (Arent, Bramble) aspects of advocacy were discussed in-depth. We will This requires diesel-powered motor vehicles to have This has been an unusually busy Interim Session with continue to learn throughout the coming year as we work emission testing as do gasoline-powered vehicles in work both in the session and in other arenas for your on a long-term project for the benefit of nurses in Utah. the less than 14,000 lbs class. Some counties do not GRC members and chairs. (See more on this in following newsletters.) require these emission tests which is poor for air quality. We have attended nearly every Joint Health and Human UNA representatives attended the Utah Health Diesel engines create about seven times as much Services Interim Session. During these sessions, we ask Policy Project fall summit in December and discussed particulate pollution as gasoline-powered engines. questions, occasionally testify, and follow issues and bills current issues in health care and policy in Utah. Keynote We encourage you check our website regularly to as they are discussed. As the Interim has just ended in speakers focused on the link between health care and see current information on these issues. Additionally, we November, we are looking at a General Session in which poverty and some suggested approaches to alleviate recommend finding UNA’s position in our Bill Tracker 1000 bills have already been submitted by legislators. what is an increasingly grave situation in Utah. We also under the Legislative Section. Members will be notified Some of these are merely place holders, but many are gathered information about the opioid epidemic, the directly of key issues as they arise. We will also be using nearly fully fleshed-out bills. There are many bills with history and use of naloxone in Utah (See article) and phone2action for those who have signed up for this list healthcare implications. We will list the more outstanding the ballot initiative for full Medicaid expansion which is for action on key bills. While we want you to be informed, ones below including a summation or short remark. underway now. (See article). we will try to keep the number of emails to a reasonable Outside of the HHS committee meetings, GRC chairs level during the General Session. If you want to sign up have attended and testified at several appropriations Impending Healthcare Bills and Issues for phone2action, send your name, physical address meetings over the interim. Most notably, we have in the 2018 General Session with zip code, your email and your phone number to supported the Nursing Consortium to garner more funds [email protected]. Nursing Consortium This proposal was developed for public pre-licensure nursing education programs; and by the Deans and Directors of Utah’s public and private we have supported, at a very basic level, more funding for non-profit pre-licensure nursing programs. This has been school nurses. While the Nursing Consortium has made heard in the Higher Education Appropriations Committee good progress this year, the funding for school nurses and has received the full support of all Presidents has been relegated back to the general session as a line of these educational institutions in the state. The item on the budget discussion. The Utah School Nurses Consortium is seeking additional funding to hire sufficient Advocacy Corner Association and the UNA will be monitoring this issue. faculty to educate more nurses in Utah. This is to address We have also testified to oppose the implementation the current and impending nursing shortages in Utah. Take Action Quick Tips of the proposed curriculum change from the State The appropriations committee has not yet decided. Board of Education (USBE), which sought to drop Family Planning Services Amendments (Ray Nurse Practice Act Rule health, PE, and art classes from required middle Ward) This bill will ask for a Medicaid waiver to allow Change about Delegation school curriculum. This rule (R277-700) change was Medicaid to pay for women who have just delivered put on hold because of the large number of opponents a baby to receive a long acting contraceptive device Watch for information about the public comment who jammed the USBE offices for the hearing this past (LARCs) on the day of delivery. Currently Medicaid will period for this suggested rule change. (See GR August. However, this issue is not dead: EVERYONE only pay for these women to receive LARCs on their first Report) UNA will post this information as soon as should contact their school board members to post-partum visit. By that point in time, if the woman was it is available on our website. We will send an email voice their concerns. (See the new Take Action column only covered by Medicaid for her pregnancy, then she will to our members to comment on this important for how to locate your state school board members.) no longer be covered, and the LARC will not be paid for. issue which will affect many nurses across a Call your local school to find contact information of local The new mother may not actually return for this visit. variety of settings. school board members. Autism Insurance Coverage Sunset Amendment The State Board will have voted on this by the time This will remove the sunset on this state ordered Keep Health, PE, and art classes required you get this newsletter; however, one option the state requirement for insurance companies to cover Autism in Utah’s middle school classrooms. board has available to them is to leave the decision in Spectrum Disorder. Therefore, insurance companies will the hands of local school boards. If this is what passes, To locate your state school board district continue to cover this disorder without repetitive reports then you MUST contact your local school boards to keep representative: to the legislature. Current reports have shown no adverse these three essential classes in the curriculum. If you do not know your state school board issue with the coverage. The GRC members all contributed to a successful member, go to www.schools.utah.gov and on the Medical Cannabis Product Review Board (Brad second Advocacy Day in October. Our keynote speaker, home page go down to the Board Information Daw) This and several other bills will establish the review Janet Haebler, shared with us valuable information section. There select the Board District Maps/ board to evaluate the safety, harms, and efficacy of about advocating for our profession, ourselves, and our Voting Information link and then select for schools’ cannabis products. patients. Our student intern, Brandie Williams, designed district maps, enter your zip code. You will see the Competency to Stand Trial Amendments (Ed handouts and was a major contributor to developing map of your area and district number. Return to the Redd) This bill will decrease the time required to initiate Advocacy Day. Attendees were enrolled into our home page, and go to Board Members to find your treatment allowing prisoners to be brought to a level of phone2action list and will be notified by this mechanism respective board member. Their bio will have their competency to stand trial. Currently, prisoners with of pending legislation and trends impacting health care email and phone number. Find your local school serious mental health or traumatic brain injuries have to and nursing in Utah. board member by calling your local school board wait prolonged times for ANY therapeutic treatments; Diane Forster-Burke and Kathleen Kaufman have or by going to their webpage. thus, decreasing the efficacy of the treatment. Dr. Redd played an active role in a Falls Prevention Taskforce testified he has seen many prisoners seriously deteriorate working with Senator Jani Iwamoto over the Interim. A Medicaid Ballot Initiative mentally due to a lack of timely interventions. He states it brochure and a website were developed to educate the is essential to initiate treatment quickly for prisoners with Support Utah’s ballot initiative for full Medicaid public about the risks for falls and serious outcomes, serious mental health problems. expansion by gathering signatures on the petition primarily in the elderly population. The taskforce is Opiod Misue Issue A controlled substance forms to reach the total number of signatures composed of multiple stakeholders who will promote database dashboard went live in November with needed for the ballot. (See article for details.) these resources as soon as the website is live. Check nine states sharing information on use and possible You can gather signatures at events, on public the UNA website for more information under the Current misuse of opioids. Metrics being shared include 1) property, on private property with the owner’s Issues tab in the Legislative Section. total active MS mg equivalents ordered/dy, 2) the permission, and by going door to door. Each We have also been invited to join with members of the number of opioid prescribers seen in six months, 3) the person can sign one petition and the person Academic Leadership Council of the UONL to consider number of pharmacies visited for opioids in six months, gathering cannot sign the petition they are barriers to clinical teaching which appear to be increasing and 4) whether the patient is currently receiving a circulating. The signatures are due by April 15th. If in our community. We have had an initial meeting with benzodiazepine-opioid combination of drugs. you take a packet and only get a few signatures, follow-up meetings scheduled. Any concerned staff nurse Multiple other opioid bills have been discussed but remember to send it back in. Also, do not let any or nurse educator is welcome to contact Kathleen Kaufman it is too early to tell which will become bills to go to the pages become disconnected from the packet. with ideas for improving the efficacy of clinical teaching in legislature. We will post a summary of ideas under Current Direct questions to [email protected] Go to facilities in Utah. ([email protected]) Issues tab in the Legislative section on our website. utahdecides.org to see how to get a petition drive Forster-Burke and Kaufman have also been Utah Decides Act This is a ballot initiative to ask the packet. discussing R 156-31b, The Nursing Practice Act Rule citizens of Utah to vote on full expansion of Medicaid. with a group of SBON members, health department and Signatures to get this on the ballot are already being Nurses Day at the Legislature February 9th DOPL officials. The goal is to clarify the exact definition gathered. (See article) of delegation outside of a school setting. We are slowly School Nurse Funding This is being referred to Come meet your legislators and address key approaching language which will more clearly inform the budget process as a line item under the Education issues in the Nurses Day at the Legislature on Feb. the licensed nurse that they have the accountability Budget. This needs to be renewed and more information 9th from 8:00 to 10:00 am in the Hall of Governors for deciding what tasks may be safely delegated to an will be posted to our website as the session progresses. in the Capitol with a workshop scheduled from unlicensed assistive person. This decision about what Increase Primary Care Network Funding Bill 10:00 am to noon in the Senate Building. may or may not be delegated does not lie in the (Steven Eliason) A proposal to increase funding for PCN control of a non-nurse administrator or a medical in Utah. The goal is to fund additional care beyond Stop Opioid Deaths Today director, but only with the nurse who is directly primary, for example, inpatient or specialty. responsible for the patient’s care. Further, this act Get education to help those in need and Full Medicaid Expansion This bill will be run again. of delegating must include training for the specific task obtain naloxone kits. Go to utahnaloxone.org for Step Therapy Bill Amendments This amendment with a return-demonstration to prove competence on information and connections. includes changes to HB 266 to support a patient’s right the part of the UAP. The public comment period for this to stay on an effective therapy when they are forced Rule change should begin in the next month or so. Once to change insurers (eg with new job, or when existing comments are considered, it may be put into Rule. February, March, April 2018 Utah Nurse • Page 9 Highlights from our Annual Advocacy Preparation Day & Annual Conference 2017

Claire L Schupbach, BSN, RN, CPC, CHP lives. Have we ever achieved that goal? Where are we mental and physical health and well-being was also now? What does the future look like? In keeping with presented. We face changes and stresses every day in To all of you who joined us for our Annual Advocacy the Healthy Nurse: Healthy Nation ANA theme for 2017, our personal and professional lives. The one piece we Preparation Day & Conference, thank you. We appreciate Danielle Howa Pendergrass, DNP, APRN, WHNP-BC, led can control is our perspective and reaction. Approaching the time and resources you spent to prepare to advocate a Keynote Address on the current impact of nurses on our worlds with a lens of gratitude can have a profound for your profession and your patients. Each year leaders leading and building a healthier community. This address positive impact. As a final gift to support you in self- from our profession, as well as legislators dedicated to focused on not only the impact we currently have, care, self-healing and coping, we were pleased to have promoting the health of Utah citizens join with us for this but also showcased how nurses innovate, inspire and Tiffany Hood, MSN, RN speak to medical errors. Our day of conversation...sharing...listening...hearing. The goal influence their worlds. Concurrent sessions are offered organization initiated a conversation on the nursing of this educational offering by UNA is in direct alignment each year and cover a range of opportunity to learn and profession and medical errors in an edition of The Utah with the ANA’s theme for 2018 The Year of Advocacy: expand your professional lives. Nurse in 2017. As expected, this is an uncomfortable Inspire, Innovate, Influence. Of vital importance in Utah is the ratio of school subject not often approached outside of quiet whispers Janet Haebler, MSN, RN Senior Associate Director, nurses to the student population. Lacey Eden MS, and confidential emails and documents. It is critical that State Government Affairs – American Nurses’ Association NP-C and Katie Maxwell, SN presented guidance on the we as a profession have open, honest and supportive joined us for the Advocacy Preparation Day and gave school nurse’s role during a disease outbreak. As you discussions around this sensitive issue. an empowering and encouraging Key Note Address on can see by the graphic provided, Utah falls very short We are excited each year to gift all nurses in Utah Harnessing Nurses Political Power. She reminded us on any recommendation for school nurses. If this is a with the opportunity to be supported, advocate, receive of the tremendous power we have as a profession to health issue you are concerned about please follow bills education, participate and focus on self-care and enact change and improve the health of our community. during this upcoming legislative session that address the professional and personal self-improvement through the Marianne Craven, PhD, RN showcased the tremendous extreme shortage of school nurses in our state. annual conference. Please watch the paper, our Facebook collaboration within Utah that has formed The Utah 2017 was a year designed to support nurses in page and your email for the dates of the 2018 Annual Nursing Consortium. Kathleen Kaufman, MS, RN, focusing on themselves rather than only on serving Advocacy Preparation & Conference days. We covet your provided a hands-on workshop on working with the others. Unless we take care of ourselves we cannot involvement and contributions. Thank you to everyone legislative system and tools to move bills forward and take care of others. Perry Gee, PhD, RN a nurse who played a part in the success of this conference. collaboration with legislators. We live in a world of social scientist talked about burnout, resilience and the work media with powerful tools with the ability to rapidly environment. This comprehensive view of the personal impact any issue. Angela York, BSN, RN and Diane cost of burnout and the business cost was also mirrored Forster-Burke, MS, RN presented tips and tools on how in the session led by Kreg Gillman PhD MBA, Licensed to best utilize this form of communication for professional Psychologist and Certified Mental Health Counselor and advocacy. Finally, Erin Marshall, MA, RN & Lacey Eden CEO at UHS – Salt Lake Behavioral Health. The negative MS, NP-C presented a Case Study of Immunization impact of stress personally as well as on the quality of Advocacy to highlight the successful outcomes that can nursing care was demonstrated by Evy Warmbier, MSN, be realized through active engagement in advocacy. BBA, RN, CNE. As we care for patients, regardless of Advocacy Preparation Day concluded with a press our role (bedside, ER, management, etc.) the negative conference with the UNA Board of Directors and SLCPD impact of stress on patient care must always be in our Police Chief Mike Brown. In the spirit of advocacy and minds. Innovating and influencing in our profession cross-professional collaboration UNA leadership and stands on a foundation of constant education. Blaine SLCPD leadership issued joint statements on the incident Winters, DNP, ACNP-BC, Daphne Thomas, MSN, RN, UNA Conference Perry Gee, PhD, RN with Alex Wubbels, RN. The UNA is appreciative of the and Craig Nuttall DNP, FNP used the current critical opportunity to work closely with our sisters and brothers topic of Post-Concussion Syndrome to demonstrate that serve daily in protecting our communities. We look development of ANCC approved continuing nursing forward to continued aligned effort. education opportunities. If writing continuing education The Annual Conference day was themed around the opportunities speaks to you as you consider your role ANA’s 2017 theme, we rephrased it as “Healthy Nurse: in influencing and advocacy please reach out to Blaine Healthy Utah.” Kathleen Kaufman, MS, RN led with a Winters. He is your Director of Education. A concurrent conversation centered around nurses living balanced session on gratitude, and how it changes your emotional,

UNA Advocacy Preparation Day UNA Conference Press Conference UNA Conference Danielle Angela York, BSN, RN, Salt Lake City Police Chief Mike Howa Pendergrass. DNP, Janet Haebler, MSN, RN, Brown, Aimee McLean, BSN, RN APRN, WHNP-BC Brandie Williams, BSN, RN

UNA Conference Utah School of Nurse Ratios Medicaid Expansion Ballot Initiative– WE Can Do It !!! START YOUR ADVENTURE Now Hiring Kathleen Kaufman, MS, RN, BC GRC Co-Chair This expansion will cover anyone who earns up to RNs, LPNs, & CNAs 138% of the federal poverty level. (for an individual and • Sign-on Bonuses Up To $3000 After writing to you for four years about our for a family of four.) Charity care has been proven not to Legislature’s failure to enact full Medicaid Expansion in provide adequate care to the poor in our state. Yes, we • New Competitive Wage Scales Utah, I can now send you positive news. WE can make may save the critically injured, but we give them virtually • Set Schedules this happen. no follow-up care. We may pay for cancer surgery but A new organization has been formed for full not for the chemo or radiation that is needed after the expansion. This organization is Utah Decides. Their surgery. We have proven that charity care is not providing only focus is to put a ballot initiative on the 2018 ballot a comprehensive solution. Polls conducted among the to let the citizens of Utah vote on this major issue. The public shows the public does understand that Medicaid decision of the voters of Utah will carry the same weight should be expanded. as a vote of the full Utah Legislature. The governor will Contact receive the results of this ballot as a law to sign or to www.avalonhealthcare.com/joinus veto, just as any other bill. 385-246-5375 Utah Nurse • Page 10 February, March, April 2018 NURSES ON THE NATIONAL FRONT CGFNS International In Its 40th Year

Leah Curtin professionals from 189 countries. Using our state- One of the biggest barriers to mobility is educational of-the-art, one-of-a-kind educational database, our portability. By becoming the migrant’s career partner Reprinted from American Nurse Today fundamental objective is to serve the global community from the moment that he or she orders the first service December 2017 through programs and services that verify and promote to the moment services are no longer needed, CGFNS knowledge-based practice competency. Today, our staff helps verify and document the applicant’s education and Promoting nursing around the world consists of individuals from 28 countries who speak 39 experience. This is accomplished by offering applicants EDITOR’S NOTE: In recognition of CGFNS different languages. This diversity allows the organization an e-portfolio (online record) that’s available to them International’s 40th anniversary, Leah Curtin, ScD(h), RN, to serve migrating health professionals from many throughout their careers. The e-portfolio is created and FAAN, spoke with Franklin Shaffer, EdD, ScD, RN, FAAN, different backgrounds. maintained through CGFNS’s eSaved: Extended Storage FFNMRCSI, CGFNS president and chief executive officer, CGFNS’s efforts correlate with growing globalization for Authenticated and Verified Electronic Documents and to learn more about the organization’s history, current and technology. Through educational research, CGFNS eDAS: eDocument Authentication Service programs. work, and future plans. hopes to help create a world where professionals can be Through Credentials Evaluation Service (CES) reports, mobile without encountering unnecessary barriers. CGFNS makes advisory suggestions to requesting How did CGFNS get started? organizations based on credentials evaluation. CGFNS International’s story began in 1977 when What’s the CGFNS structure? The reports include CES Academic Reports, CES the United States was experiencing a severe nursing CGFNS is composed of four divisions: Professional Reports, and CVS: Credential Verification shortage and many institutions and agencies had to The Commission on Graduates of Foreign Nursing Service for New York State. rely on recruiting foreign-educated nurses (FENs). Schools (CGFNS) Unfortunately, many FENs didn’t pass the U.S. nurse Founded by ANA and NLN in 1977, CGFNS was What does the future hold for CGFNS? licensure exam. Employers, professional associations, created to evaluate, test, and certify FENs. It continues One of the most visible and exciting changes CGFNS and even the U.S. government were deeply concerned to operate as an independent, nonprofit, and neutral is experiencing is its expanding global reach. In the about this situation, which led the American Nurses immigration organization in Philadelphia. past 6 years, we’ve strengthened our global reach and Association (ANA) and National League for Nursing positioned ourselves as an authority in the credentialing (NLN) to create the Commission on Graduates of Foreign The International Commission on Healthcare continuum by offering consultation, doing research, Nursing Schools (CGFNS International, Inc.). Professions (ICHP) performing credentials evaluation, and assisting in With primary funding from the W.K. Kellogg In 1996, CGFNS created ICHP for the administration nursing education reform. Foundation, CGFNS originally intended to create a of its VisaScreen: Visa Credentials Assessment Service In 2013, for example, CGFNS expanded beyond qualifying exam to serve as a predictor of whether FENs for foreign-born healthcare professionals seeking U.S. borders to support the Canadian National Nursing could pass the RN state licensure exam before migrating occupational visas in the United States. Assessment Service in their credentials evaluation to the United States. of FENs and other healthcare professionals wishing In 1977, Adele Herwitz, executive director of the The International Consultants of Delaware (ICD) to migrate to all Canadian provinces except Quebec. International Council of Nurses, began leading CGFNS In 2000, the ICD became an independent division CGFNS also has a working relationship with nursing in the groundbreaking development of an assessment of CGFNS. Founded in 1988, and a charter member and midwifery councils throughout the world and works program for FENs migrating to practice in the United of the National Association of Credential Evaluation on a number of projects with the International Council States. Ms. Herwitz, who used her personal credit card Services, ICD performs credentials evaluation services of Nurses (ICN). Our most prominent collaboration with to finance CGFNS’s initial expenses, was an advocate for academic admission, healthcare professional ICN is our partnership through the International Centre for nurses around the globe, and she played a major licensure, employment, and immigration. Under ICD, on Nurse Migration, an academic center dedicated role in establishing CGFNS’s credibility by guiding the we also have an agreement with the U.S. Department to research and policy dissemination. We also hold organization to achieve two missions—protecting the of Veterans Affairs (VA) to evaluate foreign healthcare nongovernmental organization consultative status with U.S. public while fostering equitable treatment of nurses professionals who will be working in VA hospitals. the United Nations, which grants us a strategic seat at around the world. the table regarding key global decisions pertaining to In 1996, CGFNS was authorized to screen and certify The Alliance for Ethical International nurse migration, policy, and global health. CGFNS also foreign-educated healthcare professionals seeking Recruitment Practices (The Alliance) collaborates with international organizations such as occupational visas under Section 343 of the Illegal In 2014, the Alliance was acquired by CGFNS. the U.S. Office of Global Affairs, U.S. Citizenship and Immigration Reform and Immigrant Responsibility Act Its mission is to facilitate the adoption of and Immigration Services, the International Organization (IIRIRA). CGFNS is the only organization authorized to compliance with voluntary standards to ensure ethical, for Migration, the International Labour Organization, screen and certify all health care professions covered responsible, and transparent recruitment practices of the World Health Organization, the Organisation for under the act. This was a turning point for CGFNS and foreign-educated health professionals to the United Economic Co-operation and Development, and the the impetus for its expansion to vetting individuals from States. The Alliance offers educational resources World Bank. nine health professions in addition to nursing. that prepare nurses for migration and educates them Since our inception in 1977, we’ve gained international about contracts, their rights and responsibilities, and recognition for advancing the global nursing profession. What’s CGFNS’s mission? other areas of challenge or vulnerability. In September In the next 2 years, CGFNS intends to continue this Through a rigorous evaluation process, CGFNS 2017, the Alliance released its revised Code for Ethical push toward internationalization, expanding our services prevents fraud and protects the public. The staff includes Practices in International Healthcare Recruitment. even more to better help our applicants work in today’s more than 150 experts who have an average tenure of 10 globalized world. years with CGFNS. As advocates for foreign-educated What services does CGFNS provide? health professionals, CGFNS ensures due diligence CGFNS screens and certifies foreign-educated Strategic partnerships so that everyone is safe and protected (nurse migrants, healthcare professionals through its determinative CGFNS has four strategic partnerships. employers, and the public). credential assessment services, which include the International Centre on Nurse Migration (ICNM) Since its creation, CGFNS has evolved into a global VisaScreen: Visa Credentials Assessment Service, ISNP: CGFNS and the International Council of Nurses (ICN) enterprise, touching the lives of nurses and healthcare International Standards for Professional Nurses, and the created the ICNM to serve as a portal for policy, CP: CGFNS Certification Program. research, and other information regarding global nurse migration trends and statistics. National Nursing Assessment Service (NNAS) In 2012, CGFNS signed a 7-year contract with the NNAS in Canada to design a harmonized technology-based assessment system for evaluating internationally educated nurses seeking licensure in its provinces. American Nurses Credentialing Center (ANCC) To advance its impact and scope, CGFNS established an exclusive and strategic partnership with the ANCC in August 2017. ANCC will collaborate with CGFNS to certify and evaluate baccalaureate degree eligibility and licensure requirements for nurses educated outside of the United States. This information will be used to verify the prerequisite requirements for the ANCC’s Accreditation Program, Certification Program, Magnet Recognition Program®, and Pathway to Excellence® Program. United Nations (UN) On August 14, 2015, CGFNS was approved by the United Nations’ Economic and Social Council as a Non-Governmental Organization with consultative status to the UN. This status provides CGFNS with access to many high-level meetings of the UN and a number of other important, invitation-only Learn how to apply at www.utnurse.org/Education events.

Nurses on the National Front continued on page 11

February, March, April 2018 Utah Nurse • Page 11 Nurses on the National Front continued from page 10 The CGFNS applicant experience A typical CGFNS applicant follows this process. Research: An applicant researches CGFNS, decides where he or she wants to migrate and then which services are needed to achieve that goal. Order: The applicant completes an online application and submits it along with the designated payment. Credentials collection: The applicant downloads and mails the required forms to his or her educational institution, authorizing the release of information to CGFNS. The institution sends forms and transcripts via a sealed envelope to CGFNS for review. CGFNS and the institution work together to ensure all of the applicant’s educational information is included. Evaluation: The applicant’s documents are assigned to a CGFNS credentials evaluator to perform a verification assessment. Delivery: When the evaluation is complete, it’s sent electronically to the state board indicated by the applicant. The standard processing time is 4 to 6 weeks after receipt of all required documentation. However, additional verification may be required, which may delay processing. Utah Decides Healthcare has provided this “Signature Gathering 101” as a guide for anyone desiring to join the effort to place full Medicaid expansion on the ballot. Please note the contact information for any questions. Signature Gathering 101 Each packet will hold up to 200 signatures. Even if you can only commit to 25, 50, or 100 signatures we still NEED your help, and want you to collect those signatures!

In order to gather signatures for the Utah Decides Healthcare Ballot Initiative: • you MUST be at least 18 years of age • and be a Utah resident (your principal place of residence is in Utah and you intend to continue residing in Utah)

What counts as a verified Signature: • You, the Petition Circulator, CANNOT sign your own petition packets, but you can sign someone else’s packet Want To Be a Superhero Nurse? • You, the Petition Circulator, CAN sign other ballot initiative’s packets Utah Nurses Foundation (UNF) has funds to help those who desire to • You CANNOT share your petition packet with other circulators • You CANNOT pay or give anything of value to any person for signing or become nurses support making application to nursing school. to encourage them to sign • Any Utahn can sign the petition Students who apply and are accepted to nursing school can petition the • The signature only counts towards our goal if: UNF for reimbursement of their application fee. o They are a Utah Resident who is registered to vote by the time the county clerk verifies their signature • The signor must: More information about the “HERO FUND” can be found under the Utah o Only sign once Nurses Foundation Tab on the UNA webpage: http://www.utnurse.org/ o Only sign for themselves (a person may not sign the packet for another) o Sign in the presence of the Petition Circulator (the Petition Want To Support a Superhero Nurse? Circulator must witness each signature) o Print their name—Must be legible to be verified and counted by Donations for the “HERO FUND” – a fund set up in honor of “Nurse Hero” the County Clerk o Sign their name Alex for advocating for her patients above herself – can be made through o Provide their birthdate or age (this is optional but helps the the Utah Nurses Associate Webpage: http://www.utnurse.org/ More in- county clerks) formation about the HERO FUND can be found under the Utah Nurses o Provide their street address, city, and zip code Foundation Tab. Where and how can you collect signatures: • Anywhere on public property is free game! • If you want to collect at an entrance of a location, like a grocery store, you should talk to the business first! • Within your book clubs, social clubs, ski club, PTA, work meetings, etc. • Outside public events on public property (rallies at the capitol, local high school football games, libraries, parks)

What’s in your packet? Each packet contains the following: • A Unique Packet ID number • Locations the Public Hearings were held • Text of the legislation we are proposing • A copy of the Governor’s Office of Management and Budget Fiscal Note Statement • Signature line boxes • Verification printed on the last page of each initiative packet

When/how to turn your packets in • Fill out the verification statement on the outside of the packet • Packets cannot come undone, otherwise the signatures collected will not count • Even if you did not get all of the signatures that you committed to, please still send in the signatures you have! • Return the packet back to the Campaign by mailing it to: 10 W 100 S #300, Salt Lake City, UT 84101 • If you need assistance in getting the packets back to the campaign you CONTACT: Michelle Beasley, BSN, RN can call us at: 801-706-7831 or emailing: [email protected] Director of Nursing Recruitment Relocation bonuses available | Excellent benefits Email: [email protected] DOC# 2760889.v1-12/4/17 IHS or NHSC loan repayment program eligible Phone: 928-729-8394 Utah Nurse • Page 12 February, March, April 2018 Introducing your newest UNA Nurses Play a Critical Role in Board Members Helping Teens Get Vaccinated

Claire L Schupbach, BSN, RN, CPC, CHP Audrey M. Stevenson, PhD, MPH, FNP-BC

We are blessed to have two more colleagues offer their time and expertise to As nurses and nurse practitioners, we tackle a lot of topics with teen patients. serve us all. Elections were held earlier this fall; we are proud to announce the results. However, we must not forget the importance of a subject we’ve discussed since birth Heather Lowe, BSN, BS, RN has been elected as Secretary and Jason M. Martinez, – vaccination. Too often we still see headlines about vaccine-preventable diseases BSN, RN has been elected as Director-at-Large. impacting teens. We need to do more to help teens get their necessary immunizations. Part of the application process requires a “ballot statement” or passion statement, The CDC recommends at least four routine vaccines for this age group: as I call it. There are no words I could say here that would introduce their hearts more meningococcal meningitis vaccine (MenACWY)*; human papillomavirus (HPV) vaccine; 1 clearly than their heartfelt passion in their own words. I give you Heather and Jason’s tetanus, diphtheria and acellular pertussis (Tdap) vaccine; and influenza (flu) vaccine. Ballot Statements. Two of these four vaccines, MenACWY and HPV, need to be administered as multi- dose series.1 However, the latest CDC National Immunization Survey-Teen results reveal that completion rates for the MenACWY series are dismally low – in 2016, only 39.1% of Heather Lowe, BSN, BS, RN teens received the recommended second dose, as compared to 82.2% of teens who received the first.2 In Utah, only 41.3% of girls completed the HPV vaccination series, There is a strong need for more nurses to advocate for themselves and our compared to the national average of 49.5%. Additionally, 20.3% of boys completed the profession. We are lucky to have a conduit like the Utah Nurses’ Association (U.N.A.) to HPV vaccination series, which falls far below the national average of 37.5%.2 assist us with making our voices heard on a large scale. Rather than complaining in the As nurses know, under-vaccination can bring disastrous consequences. Meningitis, breakroom about specifics with healthcare policy reform and better compensation for though rare, can cause death or permanent disability in a matter of hours.3 More than nursing staff, I would like to take a more active role in that advocacy within the U.N.A. 31,500 women and men are affected by a cancer caused by HPV annually, which As an intensive care nurse, I often see people at their worst, but am blessed to see means a new, potentially preventable case occurs every 20 minutes.4 Looking at Utah’s miracles on a regular basis as well. These modern-day miracles in healthcare are what adolescent vaccination rates, clearly more is needed to see that our teens receive the drive me and give me the overwhelming passion for both intensive care medicine and recommended vaccinations. the advancement of preventative medicine and early intervention with health issues The immunization community is coming together to help address this issue. One in our communities. With the continuing issue of burnout among nurses, especially such effort is the establishment of the Adolescent Immunization Initiative (AII), a in critical care and emergency settings, better treatment and pay for nurses, both in multidisciplinary group of experts including health care providers in adolescent health Utah and nationwide is also something I hope to find a way to positively impact. I look and immunization, convened with the support of the Immunization Action Coalition forward to assisting the U.N.A. in their endeavors to better the situations that impact (IAC) and Sanofi Pasteur. The AII’s mission is to work with stakeholders to firmly nurses and healthcare in Utah and nationwide. establish a 16-year-old immunization platform, similar to the already existing 11- to 12-year-old visit that has contributed to this population’s vaccination rates exceeding Jason M. Martinez, BSN, RN Healthy People 2020 goals for the Tdap vaccine and the first dose of MenACWY. An established platform could help make vaccination a routine part of the 16-year-old visit Hello fellow nurses, and improve adolescents’ overall preventive care. As a floor nurse for most of my career, I am in touch with the frontline issues. In Take a peek at the AII’s white paper, Rationale for an Immunization Platform at 16 Years of Age, to learn more. Then share it with your peers within and outside your addition, I understand the healthcare challenges that nurse’s face today. I strongly practice. Nurses can play an integral role in helping boost state vaccination rates, so let’s believe in supporting the nurses in my home state of Utah. spread the word about the importance of teen vaccination and help protect more teens If I am elected to serve as Director at Large, I plan to learn how I can best represent my against dangerous infectious diseases. Every conversation, whether it’s with a patient, peers. More so, I want to gain a better appreciation for all nursing issues. During my time parent or colleague, is an opportunity to create awareness about the importance of as Director at Large, I would like to work with my mentors and develop a better system immunization and help keep teens healthy. for improving the work place of nurses. As employers change their staffing ratios and *The serogroup B meningococcal vaccine (MenB) vaccine is also recommended for healthcare plans nurses become can be subjected to less than ideal working conditions. certain adolescents at increased risk, e.g., students on college campuses that have Finally, my efforts won’t go unnoticed as I plan to inform my audience about the recently experienced meningococcal B outbreaks.5 issues at hand and what is being done to correct the issues we face. Thank you for your vote and I look forward to serving my brothers and sisters alike. References 1. Centers for Disease Control and Prevention (2016). Vaccines for Your Children: Protect Your Child at Every Age – 11 to 12 Years. Retrieved from http://www.cdc.gov/vaccines/parents/ protecting-children/years-11-12.html. 2. Centers for Disease Control and Prevention. (2017). National, Regional, State, and Selected We create moments and Community Nursing Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, experiences that heal by Services provides 2016. Retrieved from https://www.cdc.gov/mmwr/volumes/66/wr/mm6633a2.htm?s_ complete Home Health cid=mm6633a2_w. putting health, comfort and Hospice services. 3. Confederation of Meningitis Organizations. Facts About Meningitis. Retrieved from http:// www.comomeningitis.org/facts-about-meningitis/ and well-being first. 4. CNS has provided expert Centers for Disease Control and Prevention (2017). HPV and Cancer. Retrieved from https:// www.cdc.gov/cancer/hpv/statistics/cases.htm. home care services for 5. Centers for Disease Control and Prevention. (2017). Meningococcal Vaccination: What over 80 years and we Everyone Should Know. Retrieved from https://www.cdc.gov/vaccines/vpd/mening/public/ are the oldest nonprofit index.html#should. agency in Utah. www.cns-cares.org RNs • LPNs • CNAs

Salt Lake City • Orem • Tooele • Price • St. George • Moab Layton • Brigham • Logan

Nursing Opportunities Available • Medical / Telemetry Unit Nurse Supervisor • Emergency Room Nurse • Medical / Telemetry Unit Nurse • Outpatient Clinic Nurse • Emergency Room Nurse Supervisor Sage Memorial Hospital is located in Northeastern Arizona, Ganado, Arizona For more information contact: Ernasha McIntosh, RN, BSN, DON, 928-755-4501, [email protected]. Applications available at http://sagememorial.com/careers/ Submit applications to the Human Resources Department, Fax#: 928-755-4659, [email protected] February, March, April 2018 Utah Nurse • Page 13 How You Can Reduce Opioid Deaths Naloxone Kits Available to Public

Kathleen Kaufman, MS, RN, BC & In 2014, a law was passed in Utah that permitted Diane Forster Burke, MS, RN prescribing and dispensing naloxone to the public including family members or friends of people at high Get credit for your Jennifer Plumb, MD presented information on risk for overdosing. The provider must advise the patient preventing opioid overdose deaths using naloxone to get further addiction help. In 2016, the Legislature rescue kits at the recent UHPP Health Policy Summit. passed the Opiate Antagonist Response Act enabling education efforts! Plumb is affiliated with the University of Utah’s anyone to buy and pass along kits. These kits can Department of Pediatric Emergency Medicine. be intranasal or injection; one kit will talk the rescuer Utah has the fourth highest death rate from opioid through the process. Prices range from $40 to $150 overdoses in the country. We also have the highest with costs rising as the kits become more popular. The death rate from overdoses among our veteran kit one that talks costs $4000. Naloxone should be population. If the total number of deaths from stored at room temperature. motor vehicle accidents were combined with Although the kits are available, they are not being deaths from firearms, this is still less than the sought out and are not being purchased. Dr. Plumb number of deaths due to opioid overdoses. In has established UtahNaloxone.org and is making kits 2010, the entire country saw a huge increase in opioid available free of charge. Some of the distribution points caused deaths due to a significant increase in the are at specific pharmacies and city fire stations. More use of heroin. This occurred when Oxycodone was fire stations are being encouraged to participate. Go reconstituted to make it harder to crush and inject. to UtahNaloxone.org for more details. An interactive In Utah, a person dies each day of the year from an map will show you a pharmacy that carries naloxone overdose. Two-thirds of mortalities are from prescribed near your home. If you cannot afford to buy naloxone, narcotics and one-third from illegal street drugs, such contact utahnaloxone.org and they will provide you with There are as many aspects to as heroin. These statistics are the opposite of the United a kit. If you use your kit, tell your health care provider nursing practice as there are settings States as a whole. Here in Utah, the age group with so they can adjust treatment if needed. Replace the kit and types of nursing practice. the greatest number of mortalities due to prescribed immediately. narcotics are women 45 to 54 years of age. Sadly The “needs” that are identified the second highest incidence of overdoses is seen in Be Able to Recognize an Overdose: for professional development and children age 4 and younger. These children are getting 1. Victim will not respond to stimulation such as practice enhancement will be into pills found around their homes. Dr. Plumb recently sternal rub or very painful stimuli. worked a shift at PCMC where 4 children under 4 years 2. Pinpoint pupils are fixed and nonreactive to light. as varied. of age were seen as “near misses” from accidental 3. Breathing is very slow, irregular, and has a exposure or overdose from opioids prescribed for gurgling sound. Don’t assume you can’t offer CE – adults. Heroin deaths tend to strike more young adult 4. Lips and nail beds are gray or blue, skin is cool Utah Nurses Association can help. males. and clammy. The role of the naloxone is to block effects of • Contact education@westernmsd. opiates on the body. This drug is non-addictive and it Take Action: is not a controlled substance. There are no significant If patient is nonresponsive, give naloxone. Call 911. org with questions. side effects if a person receives naloxone when they You may need to give a second dose after 3 minutes • Visit www.utnurse.org/Education are not actually overdosing on opiates. This drug if there is no sign of recovery. Simple directions are to view FAQs and application only reverses the effects of opioids, not of any other included in the kits. Draw up the one ml dose and inject substances including benzodiazepines. Naloxone this into a large muscle such as the thigh or upper arm. information. works quickly (1 to 3 min.) and its effects last from 30 An injection can go through clothing. Naloxone will to 90 minutes depending on how long the person has reverse any opiate or opioid including fentanyl. However been overdosed. However, naloxone has a shorter half- fentanyl may take a larger dose and will kill quicker than life than an opiate so that anyone who is revived with other opiates. The dose is the same for a small child, an naloxone MUST be seen in an ER for observation and animal, an adult or the elderly. probably further treatment. Otherwise the unobserved After losing her brother to this epidemic, Dr Plumb OD victim can still die from opiates circulating in the established utahnaloxone.org to prevent other families blood after the naloxone has worn off. from suffering this loss. You’ve always dreamed of being a nurse.

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Career Sphere Serving The Profession By Barbara B. Blozen the administrative responsibilities and oversight of its action on nurse licenses. You must be able to commit Reprinted from American Nurse Today individual BON. Depending on the state, the BON reports time to board service. Stalter and Arms describe six to the governor, a state agency (such as consumer competencies for BON service, including a professional December 2017 affairs or public safety), or both the governor and a state commitment and an appreciation for the ethical and legal agency. In some cases, the board may report to another processes. (See 6 competencies of board service.) Help protect the health, welfare, and safety of the public. state official or organization. Requirements for membership and application WHEN I ASK my students, “What’s the role of the A board’s composition, decision-making powers, and methods vary by state and are delineated by state nurse board of nursing?” many think it serves to protect nurses. authority vary by state. Membership typically includes practice acts. For example, in some states you submit The truth, though, is that a state’s board of nursing (BON) a mix of registered nurses, licensed practical and your curriculum vitae through the governor’s website. is charged with protecting the health, welfare, and safety vocational nurses, advanced practice registered nurses, To learn about the specific requirements for your state, of the public. and consumers. Members are appointed to their position. visit your local BON site. Or you can go to the NCSBN Board service is an important part of participation in In most states, BON authority includes overseeing website (ncsbn.org), where you can find a link to your the nursing community and a great way for emerging and regulating the nursing profession and examining state’s site. nurse leaders to get involved. The work demands time applicants for nursing licenses. In addition, most boards and attention to the BON’s mission, but the result is have the legal authority to operate a nursing program in Make an impact fulfilling and rewarding. the state, prescribe standards, set faculty requirements Serving on a state BON gives you the opportunity and curricula for schools, and perform site visits. In many to protect the health and welfare of the citizens of your BON structure states, the board determines training requirements for state. It’s a great way to contribute to the profession, The BONs in all 50 states, the District of Columbia, unlicensed assistive personnel and can impose legal build leadership skills, and give back to your community. and the four U.S. territories are members of the National sanctions or close a program. (See BON mission.) Visit americannursetoday.com/?p=35869 for a list of Council of State Boards of Nursing (NCSBN), a nonprofit selected references. organization. NCSBN is the vehicle through which state How to join your BON boards act and provide regulatory excellence for the Before joining your state’s BON, assess your time. Barbara B. Blozen is an associate professor of nursing public. Membership to NCSBN is available only to a state Members meet monthly or more often when needed at New Jersey City University in Jersey City. or territorial BON empowered to license and regulate to over-see board activities and take disciplinary nursing practice. The NCSBN’s policy-making body, the delegate assembly, has final membership approval. As state government agencies, BONs are responsible for regulating nursing practice. Each state determines SimpleWreath

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FOUNDATION Nursing Grant-in-Aid Scholarship Guidelines Nursing Research Grant Proposal

The guidelines listed below shall assist in ensuring the best possible coordination in This form is to be used to request research funding assistance from Utah Nurses receiving and processing nursing student requests for scholarships. Scholarships will be Foundation (UNF). Completed forms should be submitted electronically to UNF in care of awarded for tuition and books only. the Utah Nurses Association at [email protected]. Requests will be evaluated based on need, support for nursing and the nursing profession, and available UNF funds.

SCHOLARSHIP INFORMATION: Those receiving funds may be asked by UNF to provide personal pictures and narratives to • Scholarships must be postmarked by June 1st or October 1st of each calendar be published in The Utah Nurse indicating that UNF funds were provided for this project. year to be considered. • Applicants will receive notice of the Board’s recommendations by July 15th and October Title of project: ______15th of each calendar year. Applicant’s Name and credentials: ______

• Recipients are only eligible to receive scholarships twice. Professional Association/Affiliations (if any): ______• Applicants must abide by the criteria listed below. Are you currently a nursing student? Yes No GENERAL SCHOLARSHIP CRITERIA: If a student, what nursing school? ______The applicant must: Pursuing what degree? ______• Have a cumulative grade point average, which is equivalent to a 3.0 or higher Have you received funding for this project from any other source? Explain: on a 4.0 scale. • Be a United States citizen and a resident of Utah. 1) Describe the proposed work, paying particular attention to the evaluation criteria • Have completed a minimum of one semester of core nursing courses listed in the proposal writing guidelines (one page maximum). prior to application. Project Overview: • If a student in undergraduate nursing programs, be involved in the school’s chapter of the National Student Nurses Association. Research Process and Desired Outcomes: • If a registered nurse completing a Baccalaureate Degree or an Advanced Nursing Degree, be a member of Utah Nurses Association (state only) or a member of Utah Benefits to Patient Care and Education, Nursing Education, Nurses Association/American Nurses Association. and /or Nursing Profession: • Submit a personal narrative describing his/her anticipated role in nursing in the state of Utah that will be evaluated by the Scholarship Committee. 2) Describe the proposed budget for this project and how you would use the funds • Submit three original letters of recommendation. Letters submitted from faculty advisor provided (1 page maximum): and employer must be originals addressed to the Utah Nurses Foundation Scholarship 3) Provide contact information for you as well as someone who can attest to this project Committee. a) Personal contact information: • Be enrolled in six credit hours or more per semester to be considered. Preference will be given to applicants engaged in full-time study. b) Contact Information for individual at the School or Facility where research will be conducted: • Demonstrate a financial need. All of the applicant’s resources for financial aid  (scholarships, loans, wages, gifts, etc.) must be clearly and correctly listed (and include dollar amounts and duration of each source of aid) on the application. Each proposal will be evaluated according to the following criteria. Please address these • The Scholarship Committee shall consider the following priorities in making scholarship criteria in your description of both the proposed work and the budget. recommendations to the Board of Trustees: 1) The proposed activity benefits patient care, advances nursing education or research. ¡ RNs pursuing BSN 2) The proposed activity demonstrates merit with regarding to enhancing the discipline of ¡ Graduate and postgraduate nursing study nursing. ¡ Formal nursing programs - advanced practice nurses 3) The proposed activity clearly describes the desired results or outcomes. ¡ Students enrolled in undergraduate nursing programs 4) The proposal delineates the efficient use of resources, utilizing a complete and • The Applicant is required to submit the following with the completed application form: understandable budget narrative. 5) The proposed work offers students and nurses involved a quality, meaningful research • Copy of current official transcript of grades (no grade reports). opportunity that will merit submission for publications in a professional journal. • Three letters of recommendation: ¡ One must be from a faculty advisor, and Utah Nurse Foundation use only ¡ One must be from an employer (If the applicant has been unemployed for greater than 1 year, one must be from someone who can address the applicant’s work ethic, Committee discussion of proposal: either through volunteer service or some other form). Committee decision: Award______Do not award______¡ At least one should reflect applicant’s commitment to nursing. ¡ All must be in original form, Amount Awarded $ ______¡ All must be signed and addressed to the UNF scholarship committee. Is applicant eligible to apply for funds again? Yes______No______• Narrative statement describing applicant’s anticipated role in nursing in Utah, upon completion of the nursing program. • Letter from the school verifying the applicant’s acceptance in the nursing program. • Copy of ID from National Student Nurses Association or Utah Nurses Association with membership number.

AGREEMENT We Hire New In the event of a scholarship award: Graduates! • The nursing student agrees to work for a Utah Health Care Facility or Utah Educational The Utah State Hospital, a cutting-edge 325 bed psychiatric inpatient Institution as a full-time employee for a period of one year, or part- time for a period of treatment facility on a 300-acre campus in Provo, Utah located at two years. the base of the Wasatch Mountains, is seeking Registered Nurses, • Student recipient agrees to join the Utah Nurses Association within 6 months of Licensed Practical Nurses, and Psychiatric Technicians. Flexible graduation at the advertised reduced rate. schedules are available, with excellent benefits including medical, • If asked by UNF, provide personal pictures and narratives to be published in The Utah dental, life insurance, retirement, paid leave, etc. A sign on bonus Nurse indicating that UNF scholarship funds were received. is being offered to full time Registered Nurses and Licensed • If for any reason the educational program and/or work in Utah is not completed, the Practical Nurses, $4,000 to full time RN’s. Apply online at scholarship monies will be reimbursed to the Utah Nurses Foundation by the nursing student. https://statejobs.utah.gov. Hover over Job Search and click on Job Listings. Under locations, select Provo, and then click Apply To download application, visit www.utnurse.org. Search. You will then see the links to the job applications, click on the one you are interested in. If you have any questions contact Human Resource Office at 801-344-4271.