What You Need to Know. Al 2009 Fall W S N a B O a R D O F D I R E C T O R S & S T a F F

The Washington Nurse

H1N1 Pandemic Preparedness

A Publication of the Washington State Nurses Association Volume 39, No 3 Fall 2009

inside: What Nurses Need to Know About Seasonal Flu & H1N1

Report from Leadership Conference What We Are Doing to Educate the Public Information for Pregnant Nurses Essential Facts & Information • Web Resources Volume 39, No 3. What you need to know. al 2009 Fall W S N A B o a r d o f D i r e c t o r s & S t a f f

president Julia A. Weinberg, RN, Bow Washington State Nurses Association Vice President 575 Andover Park West, Suite 101, Seattle, WA 98188 Tim Davis, MN, RN, Mt. Vernon 206.575.7979 • 206.575.1908 fax • [email protected] Secretary / Treasurer Verlee Sutherlin, MEd, MSN, RN, Nine Mile Falls www.wsna.org Directors-at-Large Jeanne Avey, RN, Longview Ed Dolle, RN, Port Orchard Jennifer Graves, RN, MS, ARNP, Seattle The Washington Nurse (ISSN# 0734-5666) newsmaga- Judi M. Lyons, RN, Ellensburg zine is published quarterly by the Washington State Pam Pasquale, MN, RN, BC, CNE, Wenatchee Nurses Association. It is distributed as a benefit of membership to all WSNA members. A member rate of Chair, Professional Nursing & Health Care Council $10 per year is included in WSNA membership dues. Sharon Bradley, MSN, RN, Spokane Institutional subscription rate is $20 per year (Canada/ Mexico: US $26 per year; Foreign: US $39 per year) Chair, Legislative & Health Policy CounciL or $37.50 for two years. Single copy price is $5.00 Susan E. Jacobson, RN, CCRN, Yakima each prepaid.

Chair, Cabinet on Economic & General Welfare The information in this newsmagazine is for the benefit Martha Avey, RN, CCRN, Spokane of WSNA members. WSNA is a multi-purpose, multi- faceted organization. The Washington Nurse provides a forum for members of all specialties and interests Executive Director Assistant Executive Director, Nursing to express their opinions. Opinions expressed are the Judith A. Huntington, MN, RN Practice, Education & research responsibilities of the authors and do not necessarily Sally Watkins, PhD, MS, RN reflect the opinions of the officers or membership of Special Projects Manager WSNA, unless so stated. Copyright 2009, WSNA. No Darlene Delgado, RN Occupational & Environmental Health Specialist Karen R. Bowman, MN, RN, COHN-S part of this publication may be reproduced without Executive Administrative Assistant permission. to the Executive Director EDUCATION SPECIALIST Barbara Bergeron Hilke Faber, MN, RN, FAAN Bookkeeper Administrative Assistant, Programs & Operations Advertising Mary Reed Hue Tran Information on advertising rates may be obtained on Assistant Executive Director, Assistant Executive Director, Labor Relations the WSNA website (www.wsna.org) or by contacting Governmental affairs and operations Barbara E. Frye, BSN, RN the WSNA Business Agent at 206.575.7979. Advertis- Anne Tan Piazza ing deadlines are: March 1, June 1, September 1, and Assistant Director, Labor Relations December 1. Advertising will be accepted on a first Contract lobbyist Christine Himmelsbach, MN, RN Tamara Warnke come, first served basis for preferred positions, pending space availability. WSNA reserves the right to reject General / Corporate Counsel advertising. Paid advertisements in The Washington Senior Governmental Affairs Advisor Timothy Sears Sofia Aragon, JD, BSN, RN Nurse do not necessarily reflect the endorsement of General Counsel the WSNA Members, Staff or Organization. Communications Specialist Linda Machia Lillie Cridland Michael Sanderson WEB & COMMUNICATIONS SPECIALIST Paralegal Contributor G u i d e l i n e s Ben Tilden Maria Pettit Article ideas and unsolicited manuscripts are wel- Operations / Systems Administrator Senior Nurse Representative come from WSNA members (300 word maximum). Duncan Taylor Kathi Landon, RN Please submit a typed copy and digital copy (Word 97/2003/2007), and include identified relevant photos, Membership Coordinator Nurse Representatives a biographical statement, your name, address and Mary Peterson Debra Bessmer, BSN, RN credentials. It is not the policy of WSNA to pay for Margaret Conley, ARNP, RN articles or artwork. Membership Processors Sara Frey, JD, BSN, RN Patrick McGraw Carmen Garrison BSN, RN Louise Hohbach Michelle Huskinson, RN Judy Marken, BSN, RN Membership Processor / Clerical Support A r t i C l e s u b M i s s i o n d e A d l i n e s Pat McClure, RN Kelly King Hanna Welander, BSN, RN Communications Processor Heather Worbets, BSN, RN Spring ...... February 15 Ed Zercher, BSN, RN Kathryn MacLeod Summer...... May 15 Nurse Organizers Receptionist / Mail Clerk Jan Bussert, BSN, RN Fall ...... August 15 Irene Mueller Tara Goode, BA, BSN, RN Winter...... November 15 Mara Kieval, BSN, RN

2 | The Washington Nurse | Fall 2009 Contents

FEATURED Up Front

4 President's Letter 6 Calendar of Events 6 You Were Represented 7 2010 Dues Rates Chart 8 News Briefs 9 ANA News

Legislative Affairs

20 2009 Voter's Guide 21 Missed Breaks Survey 22 Journey to Washington, D.C. 24 A New Campaign for Health Care Reform

WHAT YOU NEED TO KNOW Labor Relations

26 Protecting Jail Nurses 26 Sidewalk Social at UWMC Seasonal Flu 27 Mandatory Vaccination Fight 10 Prevalence 28 2009 E&GW Awards 30 Photos from 2009 11 Vaccinations Leadership Conference 11 WSNA's Position Regarding Flu Vaccine 12 Masks for Seasonal Flu Nursing Practice & Education

H1N1 32 Liability Insurance 34 Continuing Education Calendar 13 Introduction 36 Upcoming Workshop: Violence in the Workplace 14 Vaccination Recommendations

15 Status of Vaccine Back of Book 15 Masks for H1N1 37 District News Surveillance of Health 16 38 Membership Update Care Personnel 39 New Members 16 Nurses Who Are Pregnant

17 Protecting Yourself

18 Helping Your Community

The Washington Nurse | Fall 2009 | 3 In Focus

byJulia Weinberg, RN WSNA President

have had the opportunity to attend several health our population. But access is only one piece of the care reform rallies, participate in a health care puzzle, we also need to make sure that this health I reform panel, and be in attendance at a few of the care is affordable for everyone. town hall meetings that Congressman Larson held I have come to develop several core beliefs about here in my region of the state. health care, and I’ve heard many others share these I have talked with nurses who feel much like I do same thoughts during those town hall meetings and when it comes to health care reform and others who conversation: have differing opinions. What was good about all • No one should ever have to be concerned of these conversations and interactions is that we about not being able to afford or access health talked. We didn’t yell or call each other names – just care at any time in their lifetime. had good dialogue about the pluses and minuses of what is out there now and of the various bills already • There needs to be a huge emphasis on public in the Senate and House for our review. What we did health and education, on health promotion all agree on was that our current health care system is and on disease prevention. indeed broken and in need of serious reform, though • We all will benefit if incentives are created that we differ in our views of what that reform should be. reward those who actively seek to improve WSNA and ANA support a public option that would their health by getting vaccinations, receiving allow for people who do not have insurance (and regular screenings, exercising, living a healthy possibly more people) to choose a federally admin- lifestyle, and availing themselves of preventive istered health care insurance plan. Insurance com- care. Rewarding people with chronic condi- panies have promised to help reform the system but tions who go the extra mile in managing their we need real accountability to ensure that they will condition(s), under the guidance of a primary help bring down costs, put caps on the out of pocket care provider, will be especially beneficial. costs for patients and families, stop denying cover- When I attended the forums, the rallies and the town age for preexisting conditions, and not make gender hall meetings or watched them on TV (as many of a factor – in effect discriminating - in the services us did), I began to see and understand how much health plans provide coverage for. We need to hold misinformation was really out there. People were insurance companies accountable and a quality pub- certainly fearful, though many either did not know lic plan would do just that. the facts or had heard only those who wanted to dis- rupt the debate and cause panic. It’s true that real reform means big changes, but that change that will We need to make sure that there is access to care, be good for most of us. However, there are also people but access is only one piece of the puzzle. We who make a lot of money under the current system also need to make sure that this health care is and they are certainly working hard to maintain the affordable. status quo.

WSNA made the decision in August to launch our We need to make sure that there is access to care own website so that nurses and the public can get the which means having enough primary providers facts’ about health care reform at Nurses4HealthRe- across the country – including enough registered form.org. The site gives nurses and others the abil- nurses and advanced registered nurse practitioners ity to make informed decisions based on facts and – to make sure we can meet the healthcare needs of

4 | The Washington Nurse | Fall 2009 not fears. It also lays out WSNA’s four The prediction is that this will be a seri- priorities for health care reform: The prediction is that this will be a ous pandemic flu year, and we’re already seeing this begin. All of us need to be pre- 1. Guaranteed access to quality care in serious pandemic flu year, and we’re pared and ready. We need to remember a timely fashion in a convenient set- already seeing this begin. to first be responsible for our own health. ting by the most appropriate health We then need to do all we can to help pre- care provider at an affordable cost. Speaking of health care and prevention, vent the spread of disease. We do this by 2. Focus on prevention and primary I also want to take the time to ask each protecting ourselves and getting our flu care so that people can receive of you, “Have you had your seasonal flu shots so that we are ready and prepared regular check-ups and early treat- shot yet?” I have! I want to encourage all to care for others. Protect yourself, your ment, leading to better health and of our nurses to get your seasonal flu shot patients, and your family by getting your lower costs for all of us. now AND to make sure you also follow vaccinations, staying informed, and fol- through when the H1N1 shots become lowing safety measures.  3. A strong public option to increase available and that your receive your H1N1 competition and keep insurance vaccination. companies honest. 4. An adequate supply of well-educated, well-distributed, and well- utilized registered nurses to meet the health care needs of the country Be a HealtH Care leader with an advanced education for busy professionals The website also contains an automated email system that lets you send a message to your elected officials, a mythbusters page that separate fact from fiction, stories from other nurses about our failing health Develop the management care system, and links to other resources skills you need through a and more information. flexible program format while continuing to work: Congress is back in session and health care is already shaping up to be the biggest » Executive Master of issue this year. Let us all do our best to Health Administration keep in touch with those who will be mak- » Certificate in ing the final decisions about our health Medical Management care and what real reform looks like right here in America. One nurse’s voice begins the message, but 2.9 million nurse voices can carry it in for a win.

I for one want to see real health care reform now! The status quo is not accept- able for me, how about you? School of Public Health and Community Medicine Department of Health Services www.depts.washington.edu/mhap

The Washington Nurse | Fall 2009 | 5 You Were Represented Upcoming Events

October 2009 ■ The WSNA staff and elected and appointed leaders represent your interests in a wide 23 Workshop: Restoring & Retaining variety of meetings, coalitions, conferences and work groups throughout the year, anticipating Nurses in Recovery and responding to the issues the membership has identified as priorities. In addition to many Cedarbrook Conference Center, SeaTac meetings with legislators, regulators, policy makers, other health care and nursing organizations and unions, the following represents a partial listing of the many places and meetings November where you were represented during the months of July through September 2009. 11 Workshop: Violence in the Workplace Clarion Hotel, Yakima 19 Workshop: Violence in the Workplace Spokane, Red Lion River Inn • Washington State Nursing Care Quality • Transition to Practice workgroup for Master Assurance Commission (NCQAC) and its Plan for Education, WCN December Practice, Education and other subcommittees • Faculty Compensation workgroup for Master 3 March of Dimes • Department of Health meetings Plan for Education, WCN Nurse of the Year Awards Hilton, Bellevue • Governor’s Invitational Pandemic Flu • Johnson and Johnson Promise of Nursing Summit Steering Committee 25 WSNA Offices Closed for Holidays Through January 1, 2010 • Meetings with the Department of Labor and • Washington State History Museum Nursing Industries Centennial Planning Committee February 2010 • Puget Sound Health Alliance Consumer • Opening of the Nursing Centennial Exhibit at 8 Nurse Legislative Day Engagement meetings Washington Museum of History Olympia • Puget Sound Health Alliance Aligning Forces • Council on Nursing Education in Washington for Quality meetings State (CNEWS) semi-annual meeting March • Healthy Washington Coalition • NWONE Nursing Practice Commission 18 WSNA Hall of Fame Awards Seattle • Stand up for Health Care Reform Rally • NWONE Spring Meeting • No on I-1033 coalition meetings • AONE Practice Policy Committee • Working Families Caucus • Toxics Free Legacy Coalition Steering Committee NursiNg • United Labor Lobby • Health Care Without Harm Nurses Work • Friends of Basic Health Coalition Group Program • Health Coalition for Children and Youth • Alliance of Nurses for Healthy Environments RN to BSN degree • Health Care for America Now (HCAN) Advocacy/Policy Group Master of Nursing • Safe Patient Handling Steering Committee • Ruckelshaus Steering Committee’s Nursing Course content relevant to Quality Indicators webcasts your clinical practice. • Public Health Funding Roundtable • Ruckelshaus Safe Staffing Steering • Nursing classes 1 day/week • Washington State Budget Crisis Coalition Committee Meetings • BSN in Bothell and Mt Vernon • Washington Health Foundation Board • Ruckelshaus Immediate Staffing Alert Task (minimum 4-5 quarters) Meeting Force • MN Friday classes (7 or 11 quarters) • Foundation for Health Care Quality re: • Ruckelshaus Education Advisory Committee SCOAP Program (Surgical Care & Outcomes [email protected] Assessment Program); • NFN National Executive Board meetings & www.uwb.edu National Advisory Board meetings • Washington State DOH Adverse Event Committee • ANA Nursing Practice Network conference calls • Washington Patient Safety Coalition - Medication Safety Initiative meetings • ANA Board of Directors meeting • Washington Center for Nursing (WCN) • ANA Business Arrangements Task Force Board Meetings • ANA Constituent Assembly Executive • Washington Center for Nursing Master Plan Committee All-Chairs Meeting • Nursing Students of Washington State Board • Washington Center for Nursing Curriculum Meeting Innovations Workgroup • 2009 WSNA Annual Leadership Conference

6 | The Washington Nurse | Fall 2009 2010 Dues Rate Schedule Effective January 1, 2010

WSNA dues are adjusted annually on January 1st each portion of the dues in 2010. The total amount of WSNA employer, FTE status, layoff or leave of absence. Write to: year based on a formula approved by the membership member dues include WSNA, ANA and District dues Membership – Washington State Nurses Association, in 1991 and revised in 2003. The formula is based on where applicable. Members who work less than 80 575 Andover Park West, Suite 101, Seattle, WA, 98188. the statewide average of the 5th-step wage rate for hours per month, are retired or not represented RNs in WSNA represented bargaining units. This for collective bargaining may qualify for one of the calculation is made from existing contracts in effect reduced dues categories. Below is the updated WSNA WSNA Dues: The amount of dues you pay includes on July 1st each year. The average 5th step monthly dues rate schedule, effective January 1, 2010. the ANA, WSNA and the District Nurses Associa- salary is then multiplied by a dues adjustment factor tion dues portions. This combined amount is based of 1.00% and again by 12 to determine the amount If you are currently a member and have had a change on the following information 1) the District you are for the annual WSNA portion of the dues to be and in your employment situation, please complete a employed in, 2) the total hours you are scheduled to applied in January the following year. The amount of Change of Information Card or email your changes work per month (FTE), and 3) whether you are cov- the dues increase for 2010 for the WSNA portion of to [email protected]. The Change of Informa- ered by a WSNA collective bargaining contract or not. the dues will be 4.7% ($2.36 per month) for members tion Card is available on the WSNA website under Eight percent (8%) of the WSNA portion of the dues of in our highest dues-paying category. The ANA por- “Membership”, or you can contact the WSNA Mem- WSNA collective bargaining members are returned to tion of the dues are adjusted every two years based on bership Department at 800.231.8482 or 206.575.7979 to the WSNA Cabinet on Economic and General Welfare the Consumer Price Index (this increase is capped at request one. Please note: It is the member’s responsibil- (4%) and to the members local unit (4%) for their use. a maximum of 2%). There is no increase in the ANA ity to notify WSNA in writing of any changes in address,

WSNA Districts: The District’s portion 01 Whatcom 07 Chelan / Douglas / Grant 14 Whitman of your dues are determined by the 02 King 08 Grays Harbor 15 Benton / Franklin county’s geographic boundaries where 03 Pierce 09 Snohomish 16 Skagit / Island / San Juan you work. If your county is not listed, you are included in District 98. 04 Spokane / Adams / 10 Wahkiakum/Cowlitz 17 Kitsap Lincoln / Pend Oreille 11 Clark/Skamania 18 Kittitas 05 Walla Walla / Columbia 12 Clallam/Jefferson 98 All others not listed 06 Yakima City / North Yakima 13 Thurston

WSNA Categories: I - Employed an average 80 hours or more a month and I V – Employed an average of less than 40 hours a month and working in a bargaining unit facility. working in a bargaining unit facility OR - Generic Graduates within 6 months of graduation (for the 1st II - Employed an average 40 hours or more & Less than 80 year of membership ONLY) OR hours a month and working in a bargaining unit facility. - Employed less than 80 hours per month and NOT covered III - Employed an average 80 hours or more a month and NOT by WSNA collective bargaining OR covered by WSNA collective bargaining. - Unemployed. V - 62 years of age and not employed or totally disabled.

Members Covered by a Bargaining Unit CATEGORY I CATEGORY II CATEGORY IV DISTRICTS Annual *Installment **Monthly Annual *Installment **Monthly Annual *Installment **Monthly 1,6,8,17,18 802.80 268.93 66.90 609.60 204.53 50.80 416.40 140.13 34.70 2 856.10 286.70 71.34 649.58 217.86 54.14 443.05 149.01 36.92 3 811.30 271.76 67.62 615.98 206.66 51.34 420.65 141.55 35.06 4 818.80 274.26 68.24 621.60 208.53 51.80 424.40 142.80 35.38 5,15 797.80 267.26 66.48 605.85 203.28 50.50 413.90 139.30 34.50 7 803.30 269.10 66.94 609.98 204.66 50.84 416.65 140.21 34.72 12 810.30 271.43 67.54 615.23 206.41 51.28 420.15 141.38 35.02 10,13 800.30 268.10 66.70 607.73 203.91 50.64 415.15 139.71 34.60 11 812.80 272.26 67.74 617.10 207.03 51.44 421.40 141.80 35.12 9,14,98 792.80 265.60 66.08 602.10 202.03 50.18 411.40 138.46 34.28 16 807.80 270.60 67.32 613.35 205.78 51.12 418.90 140.96 34.92

Members Not Covered by a Bargaining Unit CATEGORY III CATEGORY IV CATEGORY V DISTRICTS Annual *Installment **Monthly Annual *Installment **Monthly Annual *Installment **Monthly 1,6,8,17,18 565.30 189.76 47.12 416.40 140.13 34.70 193.20 65.73 16.10 2 618.60 207.53 51.56 443.05 149.01 36.92 206.53 70.17 17.22 3 573.80 192.60 47.82 420.65 141.55 35.06 195.33 66.44 16.28 4 581.30 195.10 48.44 424.40 142.80 35.38 197.20 67.06 16.44 5,15 560.30 188.10 47.70 413.90 139.30 34.50 191.95 65.31 16.00 7 565.80 189.93 47.16 416.65 140.21 34.72 193.33 65.77 16.12 12 572.80 192.26 47.74 420.15 141.38 35.02 195.08 66.36 16.26 10,13 562.80 188.93 46.90 415.15 139.71 34.60 192.58 65.52 16.06 11 575.30 193.10 47.94 421.40 141.80 35.12 195.70 66.56 16.32 9,14,98 555.30 186.43 46.28 411.40 138.46 34.28 190.70 64.90 15.90 16 570.30 191.43 47.52 418.90 140.96 34.92 194.45 66.15 16.20 ❱ QUICK NEWS & INFORMATION

New Tamper-Resistant Prescription Pads & Paper Potential Medication Errors A new law will go into paper will have a effect July 1, 2010 seal of approval Tamiflu (oseltamivir) that requires the use issued by the of tamper-resistant Washington State for Oral Suspension pads or paper for Board of Pharmacy. The FDA has issued a Public Health Alert to notify prescribers and prescriptions. Some exemptions pharmacists about potential dosing errors with Tamiflu (oseltami- do exist such as Earlier this year, vir) for Oral Suspension. U.S. health care providers usually write for prescriptions Governor Gregoire prescriptions for liquid medicines in milliliters (ml) or teaspoons, while transmitted signed House Bill electronically, by Tamiflu is dosed in milligrams (mg). The dosing dispenser packaged 2014 to help improve telephone, or by fax. with Tamiflu has markings only in 30, 45 and 60 mg. The Agency has patient safety. This law amends received reports of errors where dosing instructions for the patient do the pharmacy practice act, and These pads or paper will have not match the dosing dispenser. Health care providers should write requires all prescriptions written one or more industry-recognized doses in mg if the dosing dispenser with the drug is in mg. Pharma- in Washington to be on tamper- features to prevent: cists should ensure that the units of measure on the prescription resistant pads or paper. This requirement will reduce forged and • Unauthorized copying of a instructions match the dosing device provided with the drug. completed or blank prescription altered prescriptions, and deter form; Read the complete MedWatch 2009 Safety summary, including links drug abuse. • The erasure or modification to the FDA Public Health alert, Dear Healthcare Professional letter Who Must Comply? of information written on [Roche] and Information for Pharmacists [CDC], at: the prescription form by the All practitioners who have practitioner; and B http://www.fda.gov/Safety/MedWatch/SafetyInformation/ prescriptive and dispensing • The use of counterfeit SafetyAlertsforHumanMedicalProducts/ucm183714.htm authority must comply with this prescription forms. law. The board is developing a review How Must They Comply? / approval process for vendors of Beginning July 1, 2010, all tamper-resistant prescription pads NSO Liability Insurance Premium to prescriptions must be written on or paper. In mid-December 2009, a increase in Washington State tamper resistant paper approved list of vendors who supply board- by the Board of Pharmacy. approved tamper-resistant paper or As of August 17th, 2009, new NSO to defend the suit as well as pay Pharmacists may not dispense pad will be made available on the nursing customers in Washing- the indemnity, if a settlement is a written prescription unless Board of Pharmacy’s website. ton State will see an 8% increase awarded, is increasing. NSO must it is written on an approved (employed) or a 15% increase increase the premiums to insure prescription paper. Approved (self-employed) in the price of their appropriate reserves to pay for cur- NSO professional liability insurance. rent and expected claims. Increases Renewal notices reflecting the rate are expected in all 50 states. B http://www.doh.wa.gov/hsqa/Professions/Pharmacy/default.htm increase for current NSO nursing There are ways you can reduce customers will be sent out and your premium payment. A nursing renewal notices for NSO corporate professional who attends an eligible NEW Accelerated BSN program at the clients who will be impacted by the risk management course can University of Washington, Seattle rate increase will also be mailed receive a 10% non-cumulative pre- The ABSN program is for individuals who have previously earned a out. mium credit for up to three years. Bachelor's degree. The program is an accelerated version of the BSN Your premium is based, in part, program and condenses the course progression into five consecutive Customer Service Representa- upon the frequency of claims (# quarters (including two summers), allowing students to complete a tives are available to answer any of claims) as well the severity of BSN degree in slightly over one year. Applications are available now. questions you have. Call the NSO claims, the amount paid to defend toll-free number at 1-800.247.1500 More Information: and settle claims. Unfortunately, (Monday through Friday, 8:00 am B http://www.son.washington.edu/admissions/absn/ the trend is that both the number to 6:00pm, EST) or you can send an of claims and the amount paid for e-mail to [email protected]. Questions: each claim continues to rise. More B [email protected] nurses are being sued and the cost

8 | The Washington Nurse | Fall 2009 ANA News

ANA Awarded Funding opportunitie s f o r i m p a c t to Boost Immunization Rates for Nurses and Public ANA Launches New Web Site to Broaden ANA has been awarded a two- Support for Safe Patient Handling Goals year cooperative agreement with the U.S. Centers for Disease s part of its long-standing effort to increase aware- important to them, a key strategy for broadening support Control and Prevention (CDC) ness about the need to eliminate manual patient in Congress. The site features background information to encourage nurses to be fully handling by registered nurses working in health and resources on safe patient handling, solutions to creat- vaccinated and to help educate A care facilities, ANA has launched a new Web site ing effective injury prevention programs, and information to promote grassroots support. on current state and federal legislation. the public and promote the merits of immunization for the The Web site, www.ANASafePatientHandling.org, encour- ANA has long advocated the use of assistive lifting equip- health of the entire nation. ages registered nurses to write their members of Con- ment and devices to reduce incidences of musculoskeletal gress in support of House Resolution 510, sponsored by injuries and back pain from lifting, moving and reposition- This CDC funding is part of Rep. Carolyn McCarthy (D-NY). The resolution would put ing patients, which are often career-ending for nurses and the 2009 American Recovery Congress on record as encouraging safe patient handling increase work-related health care costs. The nation – now and Reinvestment Act and will as a critical component in protecting nurses and patients, facing a serious nursing shortage – can no longer afford and acknowledging that manual patient lifting is associ- to lose the nurses who leave the profession annually due support ANA’s commitment to ated with high rates of injuries for health care workers. In to musculoskeletal injuries and pain. increasing the knowledge and addition to House Resolution 510, ANA strongly supports competency of nurses regarding “The Nurse and Health Care Worker Protection Act of 2009” Go to: immunization. Through print and (H.R. 2381), sponsored by Rep. John Conyers, (D-Mich.). B www.ANASafePatientHandling.org electronic communications, ANA will deliver timely messages on ANA’s Web site also encourages registered nurses to join ANA’s grassroots Safe Patient Handling Team and share the importance of immunization their personal stories about why safe patient handling is through its broad network of members, state nursing associations, affiliated specialty nursing organizations and health ANA President Among Modern Healthcare’s 100 Most Powerful People in Health Care care partners. Demonstrating the American Nurses Association President Sister Carol Keehan, The need for health care workers Association’s growing leadership role UAN President Ann Converso, Sister Mary and the general public to get in shaping discussions on healthcare Jean Ryan, Chairman and CEO of SSM vaccinated is especially critical reform, ANA is pleased to announce that Health Care, President and CEO of Health this fall because of the potential President Rebecca M. Patton, MSN, RN, Services Care Corp Patricia Hemingway- of a widespread pandemic CNOR, made this year’s list of Modern Hall, and Twila Brase, President of the outbreak of the 2009 novel Healthcare’s 100 Most Powerful People Citizen’s Council on Health Care, St. Paul, in Healthcare. More than 25,000 people MN. H1N1 virus. This ANA national were nominated by Modern Healthcare initiative will rally registered Nurses make a difference every day in ANA President readers initially; the top 100 was decided nurses to become “immunization the lives of the patients they serve. ANA Rebecca Patton by on-line voters over several weeks. is proud to see these nurse leaders recog- champions” to improve President Patton is one of seven nurses nized, and would like to thank the nurses vaccination rates (routine, on the list, including AONE CEO Pamela who showed support for their colleagues. seasonal and pandemic) in the Thompson, Catholic Health general population.

The Washington Nurse | Fall 2009 | 9 Feature Seasonal Flu and H1N1

With flu season upon us, it is imperative that nurses remain informed about influenza. Being knowledgeable can help nurses make informed decisions about protecting themselves, their patients and their families.

Types of influenza virus In virus classification, influenza viruses are RNA viruses that make up three Seasonal Flu of the five genera of the family Orthomyxoviridae. Influenzavirus A, B, and C can all cause seasonal influenza. Influenzavirus A, however, mutates the fastest, affects the widest variety of species, and includes strains which also have potential to cause pandemic flu. Prevalence Each year, between 5% and 20% of the population becomes ill with influenza (cdc, 2009). Between 1990 and 1999, approxi- INFLUENZA mately 36,000 influenza associated deaths occurred each year, TYPE: making it the sixth leading cause of death among adults in the Birds & Some Mammals United States (Thompson, et al, 2003). Between 1979 and 2001, A Most common and fastest-mutating. Has caused pandemics more than 200,000 influenza-related hospitalizations occurred in the past. Influenza A includes the following subtypes: each year. Probability estimates show that annual influenza Bird Flu Most notably: H5N1* epidemics contribute to 610,660 life-years lost, 3.1 million days Human Flu H1N1, H1N2, & H3N2* of hospitalization, and 31.4 million outpatient visits. High-risk Swine Flu H1N1* Horse Flu H7N7 & H3N8 populations such as those over the age of 65, children under 2 Dog Flu H3N8 years of age, and those with underlying health conditions, show Cat Flu H5N1 increased rates of serious illness and death from influenza and its complications. Humans & Seals B Less common than Influenza A. Slow rate of mutation Studies show that adults can shed the infectious influenza virus prevents pandemics from occurring, but also at least one day before any symptoms appear. They can continue prevents permanent immunity. to do so five to ten days after symptoms begin. Additionally, Humans & Pigs studies show that approximately 50% of influenza infections C Less common than Influenza A or B. Can cause severe can be asymptomatic. illness and local epidemics, but is less common than the other types and usually seems to cause mild Thus, transmitting influenza in the health care setting is a major disease in children concern. Health care personnel can easily spread the infection to SOURCE: http://www.wikipedia.org/ (09/2009) patients, and many of those patients can be those at the greatest * And others risk for complications including death.

10 | The Washington Nurse | Fall 2009 WSNA’s Position regarding flu vaccines nfortunately, there is no single answer to keeping our We believe that any mandatory vaccination policy should patients and health care providers healthy this flu season. only be enacted as a federal or statewide public health regu- UWe are committed to a variety of approaches to educate lation and must include the following core components: our members and the public about the importance of vaccina- • Employers must ensure that appropriate protection tion and other preventive measures. Combating the flu will and safety measures are in place to provide a safe require coordination and collaboration among many stake- workplace environment for nurses and health care holders and WSNA is already actively engaged in these efforts. workers. The WSNA Board of Directors, at its meeting on March 5, • Employers must ensure that influenza vaccines are 2007, adopted the following position: available and offered to every health care worker annually. "The Washington State Nurses Association (WSNA) is • The policy must cover all health care settings and committed to advocating for the health of nurses and health care workers. This includes all settings such the patients that they serve. Because of this commitment, as hospitals, long-term care facilities, adult boarding WSNA strongly recommends that nurses and all other homes, outpatient clinics, etc. Health care workers health care providers who provide direct patient care must include those licensed and unlicensed who work be vaccinated against the influenza virus. Absent of in close proximity to patients, e.g. nurses, emergency a Centers for Disease Control (CDC) requirement for responders, physicians, housekeeping personnel, mandatory annual influenza vaccination of all health health care secretarial staff, etc. care workers, WSNA supports voluntary efforts includ- • If a declination form is required, the nurse must be ing implementation of aggressive and comprehensive able to sign the form confidentially; that is, the nurse influenza vaccination programs for registered nurses must not be required to divulge personal health infor- that aim for 100% vaccination rates." mation or declare the reason(s) for refusal of a vaccine. The employer must not discriminate against or We do not believe that a hospital–by–hospital policy discipline a nurse for opting out. concerning mandatory vaccination is good public policy. • The employer must not discriminate against or disci- It lacks consistency and adequate protection for the pline nurses for the appropriate use of sick time. patients and workers. WSNA strongly urges each nurse to get their vaccination against the influenza and H1N1 viruses. • CDC Guidelines must be used for prevention, protection, and safety of nurses and patients.

Vaccinations congestion, runny nose, sore throat, and cough. The risk of a severe allergic reaction is less than 1 in 4 million (cdc). Getting Influenza vaccines are shown to be 70 – 90% effective in pre- the vaccine is the best protection against the disease. venting the flu when there is a good match between circulating viruses and those in the vaccine (cdc). In populations where Approximately 83% of the United States population is specifically the vaccine might be less effective in preventing influenza, such recommended for annual vaccination against seasonal influenza; as the elderly, studies show that those vaccinated experience a however, less than 40% received the 2008-09 influenza vaccine (cdc). 50 – 60% reduction in severity of disease and the incidence of Achieving 60% or higher vaccination levels for health care per- complications, and there is an 80% reduction in deaths (jcaho). sonnel is a Healthy People 2010 goal. Vaccination rates of 80% or higher might be needed to provide “herd immunity” that can Some believe that getting a vaccination will cause them to get prevent health care associated influenza by immunizing those the flu. This is a myth. A flu shot cannot cause the flu, and seri- who care for and live with susceptible people. ous problems from the flu shot are rare. Some side effects from the vaccine can include soreness or redness at the injection site. In 2005, the American Nurses Association supported a survey Those who receive the nasal mist vaccine may experience nasal of registered nurses regarding influenza vaccines. Findings

The Washington Nurse | Fall 2009 | 11 Feature | Seasonal Flu & H1N1

showed that only 5% of those responding believed that all of their co-workers had received the influenza vaccine the prior Use of Antivirals year. ANA then launched their campaign “Everyone Deserves a Antivirals such as Tamiflu and Relenza should be primarily used to Shot at Fighting Flu” to urge all nurses and health care workers treat those with influenza. Additionally, such drugs may be used to get their vaccines. for those at high risk for severe complications after being exposed to someone with influenza. It is important to note the following: ❱❱ If large numbers of people take antivirals for prevention, the Masks for Seasonal Flu virus may develop resistance to the antivirals. In that case Transmission of human influenza from person to person is pri- the antivirals would no longer be used to treat those who marily through droplets generated when an individual coughs or are ill. This is very similar to what we are now seeing with sneezes. The droplets are deposited on mucosal surfaces in the other drug resistant organisms. upper respiratory tract of those who are nearby, i.e. within 3 feet, ❱❱ This outbreak could last a long time. If you do take antivirals of the individual. Transmission can also occur through direct to try to avoid getting sick, you might have to take them for and indirect contact with the infected respiratory secretions. many months.

To decrease the transmission of influenza in the health care ❱❱ Antivirals must be prescribed by a health care professional, environment, a combination of strategies is recommended and should only be used to treat those who are ill or to (http://www.cdc.gov/flu/professionals/infectioncontrol/ prevent illness in high-risk situations. maskguidance.htm): For more information regarding the use of antivirals, consult your • Place those patients potentially infected/infected with primary care provider.

influenza in private rooms source: Washington State DOH H1N1 (Swine Flu) FAQ (09/2/2009) • Have all health care personnel, whether vaccinated or not, wear surgical masks when in close patient contact (i.e. within 3 feet) and don gowns and gloves if contact with respiratory secretions is likely WSNA's Efforts • Have infectious patients wear surgical masks to help con- We have for several years con- tain respiratory secretions and limit exposure to others ducted an annual influenza education campaign with our • During periods when community respiratory infections members and the public, are increased, offer masks to patients showing symptoms including electronic, Web, of respiratory infection when they present to a health care television, and print infor- facility. The patient should wear the mask until either mation and other efforts. isolated in private room or it is determined that their symptoms are not related to an infectious process requir- WSNA formed a partnership with the Washington State ing respiratory precautions Department of Health, Washington State Medical Associa- tion, and the Washington Health Foundation in television It is, however, worth noting that no studies have definitively and radio ads about swine flu this spring. We have once illustrated that use of masks by either health care personnel again partnered with these organizations along with the (whether vaccinated or not) or infectious patients prevents Washington State Hospital Association on television ads, in influenza transmission. Requiring non-vaccinated personnel both English and Spanish, which will air throughout Wash- to wear a mask at all times while on duty gives a false sense ington State this fall. of security to workers, patients, and visitors. In addition, WSNA has extensive information about the source: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0724a1.htm (09/3/2009) seasonal flu as well as H1N1 on our website. Be sure to check source: http://www.jointcommission.org/PatientSafety/InfectionControl/flu_monograph.htm (09/3/2009) out the television ads, articles, and resource information at source: Thompson, W.W., et al. Mortality associated with influenza and respiratory syncytial www.wsna.org/flu virus in the United States. JAMA 289: 179 – 186, Jan. 8, 2003.

12 | The Washington Nurse | Fall 2009 Symptoms of swine flu Swine Flu (H1N1) In the results of early CDC studies, the symptoms of novel H1N1 flu virus in people were similar to the symptoms of seasonal flu, although vomiting and diarrhea were reported more commonly with H1N1 flu infection than is typical for seasonal flu. ovel influenza A (H1N1) is a new flu virus of swine origin N that first caused illness in Mexico and the United States in March and April 2009. This virus spreads from person to FEVER 93% person worldwide, in much the same way that regular seasonal COUGH 82% influenza viruses spread. The Center for Disease Control and SHORTNESS OF BREATH 51% Prevention (CDC) has determined that 2009 H1N1 virus is con- FATIGUE / WEAKNESS 40% tagious and is spreading from human to human. CHILLS 37% Illness from the new H1N1 virus has ranged from mild to severe. MUSCLE SORENESS 36% While most people who have been sick have recovered without RUNNY NOSE 36% needing medical intervention, hospitalizations and deaths from HEADACHE 31% infection with this virus have occurred. One thing that appears SORE THROAT 31% to be different from seasonal influenza is that adults older than 64 years do not yet appear to be at increased risk of 2009 H1N1- VOMITING 29% related complications. CDC laboratory studies have shown DIARRHEA 24% that no children and very few adults younger than 60 years old WHEEZING 24% have existing antibody to 2009 H1N1 flu virus; however, about SOURCE: http://www.cdc.gov/H1N1FLU/surveillanceqa.htm (09/2009) one-third of adults older than 60 may have antibodies against this virus. It is unknown how much, if any, protection may be afforded against 2009 H1N1 flu by any existing antibody. As the novel H1N1 virus has continued to spread with new out- When the 2009 H1N1 outbreak was first detected in mid-April breaks during late summer/early fall 2009, the CDC anticipates 2009, CDC began collecting, compiling and analyzing infor- that there will be more cases, more hospitalizations and more mation regarding the 2009 H1N1 flu outbreak, including the deaths associated with this pandemic in the United States. The numbers of confirmed and probable cases and the ages of these novel H1N1 virus, in conjunction with regular seasonal influ- people. The information analyzed by CDC supports the conclu- enza viruses, poses the potential to cause significant illness with sion that 2009 H1N1 flu has caused greater disease burden in associated hospitalizations and deaths during the U.S. influenza people younger than 25 years of age than older people. At this season. WHO is advising countries in the northern hemisphere time, there are few cases and few deaths reported in people older to prepare for a second wave of pandemic spread during the than 64 years old, which is unusual when compared with sea- fall of 2009. sonal flu. However, pregnancy and other previously recognized high risk medical conditions from seasonal influenza appear Current evidence points to some important differences between to be associated with increased risk of complications from this patterns of illness reported during the pandemic and those seen 2009 H1N1. These underlying conditions include asthma, diabe- during seasonal epidemics of influenza. The age groups affected tes, suppressed immune systems, heart disease, kidney disease, by the pandemic are generally younger. This is true for those neurocognitive and neuromuscular disorders and pregnancy. most frequently infected, and especially so for those experienc- ing severe or fatal illness. To date, most severe cases and deaths On June 11, 2009, the World Health Organization (WHO) sig- have occurred in adults under the age of 50 years, with deaths in naled that a pandemic of 2009 H1N1 flu was underway by rais- the elderly comparatively rare. This age distribution is in stark ing the worldwide pandemic alert level to Phase 6, which is an contrast with seasonal influenza, where around 90% of severe indication of the spread of the new H1N1 virus, not the severity and fatal cases occur in people 65 years of age or older. of illness caused by the virus. Since the WHO declaration of the pandemic, the new H1N1 virus has continued to spread, with source: http://www.cdc.gov/h1n1flu/qa.htm (09/2009) source: http://www.who.int/csr/disease/swineflu/notes/h1n1_second_wave_20090828/en/index. the number of countries reporting cases of novel H1N1 nearly html (09/2009) doubling.

The Washington Nurse | Fall 2009 | 13 Feature | Seasonal Flu & H1N1

High Risk Populations Who dies from the flu? The average age of patients killed by swine flu is very different from that of those killed by and Vaccination seasonal flu. The CDC studied the hospital records of 268 patients hospitalized with novel H1N1 flu Recommendations early on during the outbreak. The number of deaths was highest among people 25 to 49 years of age (39%), followed by people 50 to 64 year of age (25%) and people 5 to 24 year of age (16%). In contrast, an estimated 90% of the annual seasonal influenza-related deaths occur in people aged 65 years or Groups at higher risk for influenza related older. 0 to 4 (2%) complications are similar to those at Unknown (9%) higher risk for seasonal influenza com- 65 & Older (9%) 5 to 24 (16%) plications. These groups include: children younger than 5 years old; adults 65 SWINE FLU (H1N1) years of age and older; pregnant women; MORTALITIES people of any age with certain chronic medical conditions (for example, asthma, diabetes, lung disease, people with weak- 65 & Older (90%) ened immune systems, etc.); and people 25 to 49 (41%) younger than 19 years of age who are receiving long-term aspirin therapy. For children younger than 5 years of age, 50 to 65 (24%) note that the risk for severe complications from seasonal influenza is highest among SEASONAL FLU children younger than 2 years old. MORTALITIES Vaccine for the H1N1 flu is recommended Other (10%) by the CDC if an individual is in any of the following groups (or lives in a household SOURCE: http://www.cdc.gov/H1N1FLU/surveillanceqa.htm (09/2009) with someone who is): • Children and adolescents aged 6 Source of swine flu months to 19 years Anne Schuchat, head of science and public on its surface, having so far circulated only in • Adults 50 years of age or older health at the CDC, said that the US version of the pigs, is one that most human immune systems H1N1 virus is an unusually mongrelised mix of have never seen — a crucial requirement for • People with chronic diseases of the genetic sequences from North American pigs, pandemic flu. heart, lungs, or kidneys Eurasian pigs, birds and humans. The H protein • People with diabetes • Those whose immune systems do not function properly .htm l • People with a severe form of ane- mia / -go-pandemic

• Women who will be more than 3 ay rticle om /a

months pregnant during the flu .c season • People who live in a nursing home Us Birds and-mexico-m or other chronic-care housing

facility newscientist ww w. // • Those in close contact with children virus-in-us- : http:

0 to 23 months of age North CE American pigs Eurasian pigs -new-flu- source: http://www.cdc.gov/h1n1flu/antiviral.htm SOUR

(09/14/2009) eadly source: http://www3.niaid.nih.gov/topics/Flu/ 5-d understandingFlu/Prevention.htm (09/14/2009) dn 1702

14 | The Washington Nurse | Fall 2009 Status of H1N1 Vaccine A preliminary report published in the New England Journal of Medicine on September 10, 2009 documents a July 2009 study conducted in Australia. This initial study of the H1N1 vaccine was comprised of healthy adults. The results of this random- ized, observer-blind, parallel-group trial on the vaccine for H1N1 appears to have elicited a robust immune response, despite the prevailing assumption that two doses of vaccine would be required. The vaccine appears to be effective within 8-10 day of the initial inoculation and may require only one injection to provide coverage for the individual.

The H1N1 vaccine may be available as soon as early October to start the inoculation process for the indicated groups which include health care and emergency medical services personnel N-95 mask PAPR mask as infections among health care workers have been reported and this can be a potential source of infection for vulnerable patients. Also, increased absenteeism in this population could reduce health care system capacity.

source: http://content.nejm.org/cgi/content/full/NEJMoa0907413 (09/14/2009)

source: http://www.cdc.gov/h1n1flu/vaccination/acip.htm (09/14/2009)

Additional information on N95 respirators and other types Masks for H1N1 of respirators can be found at: http://www.cdc.gov/niosh/ npptl/topics/respirators/factsheets/respfact.html, and at Human cases of H1N1 (swine influenza A) viral infections http://www.fda.gov/cdrh/ppe/ masksrespirators/html have been confirmed, and investigations of these cases suggest human-to-human contact is transmitting this Filtering Face-Piece Respirator (N-95): The commonly known virus. The CDC recommends that all health care person- "N-95" filtering face-piece respirator is one type of particulate res- nel entering rooms of patients with suspected or diagnosed pirator, often used in hospital to protect against infectious agents. H1N1 influenza wear a fit-tested N95 or PAPR respirator. Particulate respirators are the simplest, least expensive, and least note: This recommendation differs from that of using surgical protective of the respirator types available. These respirators only mask precautions taken for seasonal influenza. The rationale is protect against particles. They do not protect against chemicals, that “a more conservative approach is needed until more is known gases, or vapors, and are intended only for low hazard levels. about the specific transmission characteristics of this new virus” Particulate respirators are "air-purifying respirators" because (http://www.pandemicflu.gov/plan/health care/maskguide- they clean particles out of the air as you breathe. Even if you ancehc.html). The use of facemasks may be considered as an can't see the particles, there may be too many in the air for this alternative to respirators; however, they are not as effective in respirator to provide adequate protection. preventing inhalation of small particles which is one potential Powered Air-Purifying Respirator (PAPR): Powered air-purifying route of transmission. Additionally, there is limited evidence respirators use a fan to blow air through the filter to the user. They available suggesting that using a respirator without fit-testing are easier to breathe through and they need a fully charged battery may still provide better protection than a facemask against inha- to work properly. They use the same filters as gas masks, so you lation of small particles. Respirators are not recommended for need to know what the hazard is, and how much of it is in the air. children or those who have facial hair.

Those with H1N1 virus infection should be considered potentially contagious from one day before to 7 days following the onset of illness. Those persons continuing to show signs of illness after 7 days should be considered potentially contagious until their symptoms resolve. Children may be contagious for longer periods.

The Washington Nurse | Fall 2009 | 15 Feature | Seasonal Flu & H1N1

Surveillance of Health seasonal or pandemic Flu? Care Personnel What are the differences between swine flu and ■ See Interim Guidance on Antiviral Recommendations for Patients with seasonal flu? Here's how things break down: Novel Influenza A (H1N1) Virus Infection and Their Close Contacts. (CDC) Seasonal Flu vs. Pandemic Flu (H1N1) In communities where novel H1N1 virus transmission is occurring, health care personnel should be monitored daily for signs Outbreaks follow predictable Occurs rarely (three times in 20th seasonal patterns; occurs annually, century – last in 1968) and symptoms of febrile respiratory illness. Health care personnel usually in winter, in temperate who develop these symptoms should be instructed not to report to climates work, or if at work, should cease patient care activities and notify their supervisor and infection control personnel. Usually some immunity built up No previous exposure; little or no from previous exposure pre-existing immunity In communities without novel H1N1 virus transmission, health care personnel working in areas of a facility where there are patients Healthy adults usually not at risk Healthy people may be at being assessed or isolated for novel H1N1 infection should be moni- for serious complications; the very increased risk for serious young, the elderly and those with complications tored daily for signs and symptoms of febrile respiratory infection. certain underlying health conditions This would include health care personnel exposed to patients in at increased risk for serious complications an outpatient setting or the emergency department. Health care personnel who develop these symptoms should be instructed not Health systems can usually meet Health systems may be to report to work, or if at work, should cease patient care activities public and patient needs overwhelmed and notify their supervisor and infection control personnel. source: http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm (09/14/2009) Vaccine developed based on Vaccine probably would not be known flu strains and available for available in the early stages of a Nurses Who Are Pregnant annual flu season pandemic

■ Pregnant women – even those without other health conditions – are espe- Adequate supplies of antivirals are Effective antivirals may be in limited cially vulnerable to the H1N1 flu, and have a much higher rate of hospitalization usually available supply and death than the general population.

Prevention: It is very important for pregnant women to wash their Average U.S. deaths approximately Number of deaths could be quite 36,000 per year. .01% of U.S. high. The 1918 mortality rate is hands often and avoid close contact (if possible) with anyone who population dies in an average year estimated to have been up to 20% is ill. The Advisory Committee on Immunization Practices has due to seasonal flu. of those infected. With about a third of the world population identified pregnant women as a target group for primary vaccina- infected, this case-fatality ratio tion with an H1N1 pandemic flu vaccine, to protect both mothers means that 3% to 6% of the entire global population died in the 1918 and their babies. spanish flu pandemic. Treatment : Early treatment with antivirals is urged for pregnant women with suspected, probable, or confirmed cases of H1N1. Clini- Symptoms: fever, cough, runny Symptoms may be more severe nose, muscle pain. Deaths often and complications more frequent cians do not need to wait for confirmed test results to begin treatment. caused by complications, such as Pregnancy should not be considered a contraindication to antivi- pneumonia. ral use, as pregnant women appear to be at higher risk for severe complications from H1N1 and the benefits outweigh the theoretical Generally causes modest impact May cause major impact on on society (e.g., some school society (e.g. widespread restrictions risks of antiviral use. closing, encouragement of people on travel, closings of schools and who are sick to stay home) businesses, cancellation of large Pregnant women who will likely be in direct contact with patients public gatherings) with confirmed, probable, or suspected H1N1 should consider reas- signment to lower-risk activities, such as telephone triage. If reas- Manageable impact on domestic Potential for severe impact on signment is not possible, pregnant women should avoid participating and world economy domestic and world economy in procedures that may generate increased small-particle aerosols of respiratory secretions in patients with known or suspected influenza. source: http://www.pandemicflu.gov/general/season_or_pandemic.html 09/2009 source: http://www.cdc.gov/ncidod/eid/vol12no01/05-0979.htm 09/2009 source: http://www.nursingworld.org 09/2009

16 | The Washington Nurse | Fall 2009 Protect Yourself as a Health care Provider

Hand hygiene Social distancing The single most effective way to prevent the spread of Ill persons should stay home and not attend work, disease! Nurses should be sure they, their colleagues, school, church, or other social events where they will their patients, family and friends wash their hands often have close contact with others. If social interaction using soap and water or alcohol-based hand sanitizer. is unavoidable, ill persons should maintain at a distance of 3 feet and consider wearing a surgical mask. Covering cough or sneeze Use a tissue to cover a cough or sneeze to prevent the spread of infectious droplets. Other Considerations Avoid Touching Eyes, Nose or Mouth If you have Sign/Symptoms of flu Germs are spread this way. Stay home if you are ill. Laundry Wash a sick person's laundry in hot water and dry it on Obtain Vaccine for seasonal and H1N1 flu high. Wear gloves or wash your hands after touching laundry. Public health officials recommend that everyone who is eligible to receive the seasonal flu vaccine should

get it every year. If you are eligible to receive H1N1 flu source: http://www.nursingworld.org/MainMenuCategories/Health careandPolicyIssues/ vaccine when it is available, you should get that vaccine DPR/H1N1-Information/H1N1-Prevention.aspx 09/2009 source: http://www.nursingworld.org/http://www.doh.wa.gov/h1n1/h1n1_faq. as well. You may be able to receive both vaccines htm#vaccine 09/2009

at the same time, though the seasonal flu vaccine source: http://www.cdc.gov/h1n1flu/clinician_pregnant.htm 09/2009 will be available sooner than the H1N1 vaccine.

Mercury Limits Law Temporarily Suspended

Secretary of Health Mary Selecky has As a precaution, Washington state law three and pregnant women who want temporarily suspended Washington’s limits the amount of mercury that can the vaccine from getting it. H1N1 vac- limit on the amount of mercury (thi- be in vaccines for pregnant women cination will be voluntary. Pregnant merosal) in H1N1 (swine flu) vaccine and children under three. The sec- women and children under three allowed for pregnant women and retary of health can suspend the law are two of the priority groups to get children younger than three years old. when there is a shortage of vaccine or H1N1 vaccine first because they are at The six-month suspension is effective during a disease outbreak – both cri- high risk for serious complications if September 23, 2009 through March teria apply to the H1N1 vaccine. Some they’re infected with H1N1 (swine flu) 23, 2010 and applies only to H1N1 vac- H1N1 vaccine will be mercury-free, virus. cines. It does not apply to seasonal flu but it may not be available at all times vaccine. and there may be limited amounts. This could stop children younger than

The Washington Nurse | Fall 2009 | 17 e m p l o y ment opportunit y Feature | Seasonal Flu & H1N1 Nursing Practice & Education Specialist Help Your Community Interested in advancing nursing practice in Washington State? Ensuring During an Emergency nurses have opportunities for education Be a Volunteer and CNEs? Impacting standards of care?Working with the public, RNs across ■ As a licensed nurse, you have skills that will be in demand during any emergency that the state, and government agencies? Apply affects public health. The upcoming flu season, which may affect many more people than today: Nursing Practice and Education usual, could be one example. You can help your community by volunteering now through Specialist with the Washington State one of the following programs for licensed medical professionals: Nurses Association. Be a part of our dynamic team. WSNA Washington State volunteers receive a formal orienta- works to ensure the nursing profession is a thriving and influential Health Volunteers in tion, as well as ongoing disaster train- component of the health care system (WAHVE) Emergencies ing. MRC programs work closely with now and for the future. We provide local emergency management agencies As a medical professional, you can use leadership, resources and guidance so to ensure that volunteers are registered the Department of Health’s new Web- that every nurse has a safe, successful as designated emergency workers. This and fulfilling career. based system to register as a potential is important because registered volun- emergency volunteer. Once registered The Nursing Practice and Education teers are protected from liability when in the WAHVE database, you may be Specialist will facilitate the develop- participating in an organized disaster called to help during a large-scale event, ment, implementation and evaluation response activity. Registering with but there is no obligation to participate of nursing practice, education, and your local MRC unit is the most effi- if called upon. We understand that you research programs. Job duties will cient way of getting involved in public include work with registered nurses, may be needed at your primary workplace, health response activities right now, but the public, WSNA staff & committees, which may have staffing shortages during requires ongoing time commitments that coalition partners, and government an emergency. might be difficult for some medical pro- agencies. Using WAHVE, you can enter your own viders to meet. Areas of focus will include: contact information and note specialty Questions can be forwarded to Scott Carlson, ❱❱ Raising standards of nursing care qualifications and geographical prefer- Department of Health Volunteer Coordinator, through work with nurses, practice ences. Registration takes 30-45 minutes. at [email protected] or 360.236.4086. committees, etc Your information will be kept secure and ❱❱ Promoting & managing WSNA’s will be available only to appropriate public American Red Cross (ARC) professional nursing practice and health and emergency management staff education programs during an emergency. WAHVE volun- The ARC is a national agency that pro- ❱ teer information will also be shared with vides a variety of volunteer opportuni- ❱ Creating communications materi- als about nursing practice and Medical Reserve Corps units as applicable. ties for all skill levels and backgrounds. education for the WSNA website Please visit the WAHVE Web site at The ARC is well-known for providing and other WSNA publications www.doh.wa.gov/phepr/wahve/default.htm to disaster response, emergency shelter register or get more information on the Medical and feeding programs. Roles for licensed ❱❱ Identifying significant issues, Reserve Corps program. medical providers are sometimes limited. trends and developments which may impact the practice of nursing However, local Red Cross chapters are Medical Reserve integrated into almost every community, Qualifications Corps (MRC) and licensed medical providers are often Masters in Nursing and at least five asked to take on leadership or volunteer years experience in nursing. Teaching MRC programs are locally based. They are instructor roles for classes such as First experience and adult education back- composed of both medical and nonmedi- Aid/CPR. ground are essential. cal volunteers and support a variety of Visit emergency response, medical surge and More information about the American Red Cross can be found at www.redcross.org. www.wsna.org/jobs public health education activities. MRC to apply or for more information

18 | The Washington Nurse | Fall 2009 Be Thoughtful. Be Renown.

It’s more than your skills and expertise. More than your anticipation of the needs of those around you. It’s your dedication to your patients and your peers. Because for you, it’s not just about being better, it’s about being renown. Renown Health is northern Nevada’s leading health network—and a place where better is a way of life. With a complete network of two medical centers, a rehabilitation hospital, a skilled nursing facility, and multiple medical and urgent care facilities, we offer as much possibility in your professional life as Reno’s 300+ days of sunshine and over 4,000 acres of park offers you in your personal. Join us. RN Opportunities Available For more information on Renown Health or to apply, visit www.renown.org SKILL. EXPERTISE. TECHNOLOGY. www.renown.org

EOE

Washington Nurse 4/1/2009 1948209-PH33661 RENHEA 6.5” x 4.5” Audra Bergeron v.2

“Leadership and Learning Are Indispensable to Each Other.”

John Fitzgerald Kennedy, 1963 The faculty at the University of Washington School of Nursing ( UWSoN), Seattle invites you to lead and learn by enrolling in the Doctor of Nursing Practice (DNP) program.

UWSoN is proud to offer the DNP in Community Health – not only does the curriculum prepare for roles in areas such as Policy Analysts, Program Analysts, Nurse Executives and Occupational and Environmental Health Nurse Specialists – the program uses a community health leadership framework to dynamically integrate coursework and clinical internship experiences with emphasis on Communities for Youth, Cross Cultural and Global Health, Healthy Aging, Occupational and Environmental Health and Rural Health.

Distance learning (elearning) technologies are used in one-third of the courses to allow for flexible learning at home and in classrooms on Saturdays.

To prepare yourself for the future visit: http://www.son.washington.edu/admissions/ Legislative Affairs

Protect funding for health care and other critical services Vote 'No' on Initiative 1033

As the economy recovers, we could restore taking resources away from kids and funding to education and health care – but classrooms. I-1033 would make these cuts permanent Initiative 1033 will delay our economic and force even deeper cuts in the future. recovery and cause more hard times for I-1033 would lock in this year's recession- Washington families. level state, county and city budgets as baselines and apply a rigid and arbitrary I-1033 will worsen our health care The national recession has cost our state formula based on population growth and crisis thousands of jobs and forced billions of inflation to decide how much could be dollars in cuts to education and health • 35,000 low-income people are losing spent in the future. care. I-1033 would have disastrous con- their health insurance – cuts I-1033 sequences for health care, hospitals This year, 40,000 low-income people in would make permanent. and patients. And we know I-1033 is a Washington have lost their health insur- • I-1033 would lock in recession-era proven failure – it’s based on Colo- ance. As many as 3,000 teachers and cuts to nursing homes, adult-day and rado’s “TABOR” law, which caused school employees face layoffs and $1.5 in-home care. so much damage to health care that billion has been slashed from education, voters suspended it.

Uphold Domestic Partnerships Vote 'Approve' on Referendum 71

Domestic partners registered with the Medical related Washington Secretary of State have fam- Appro e rights include: ily law rights and responsibilities as well REF.71 as medical and death related rights. the right to visit a Domestic partnerships would also grant hospitalized partner, numerous benefits for the partner of a deceased individual including the ability The WSNA Board of Directors recently to administer a deceased partner’s estate, voted to support Referendum 71, which the right to participate in medical to be recognized on a partner’s death cer- aims to uphold Washington’s domestic decision-making, tificate, authorize an autopsy, receive copy partnership law. This law, passed by the of autopsy report, make an anatomical gift Legislature and signed by the Governor, the right to receive health on behalf of a partner, be able to control assures that registered domestic partners information about a partner, disposition of remains, seek damages for in Washington are treated equally to mar- partner’s wrongful death, inherit from a ried couples under state law. There are the right to privacy, and partner’s estate in the absence of a will, 12,000 registered domestic partnerships be buried as a couple, can obtain DSHS in Washington. These families live in the right to share a room in long recognition for hardship when filing a lien all parts of the state and may be elderly term care facilities. for reimbursement and for partners who people, are gay or lesbian couples, and are state employees, provide for health many have children.

20 | The Washington Nurse | Fall 2009 TE VOTEVO VOTE How to Vote This Fall • Missed Breaks Survey

S u r v e y !

• The nonpartisan Office of Financial • Colorado couldn’t afford to buy Do you get a rest break every 4 Management released a study show- students vaccines to protect against hours? Do you get a 30 minute ing that I-1033 will cut revenues for diseases like whooping cough. health care and other government uninterrupted lunch break? • Under TABOR, Colorado’s national services by $5.9 billion over the next Does your employer use on-call rank in prenatal health care dropped five years. as another form of mandatory from 23rd to 48th. overtime? I-1033 is a proven failure for health Initiative 1033 will delay our economic care recovery and cause more hard times for We need to hear from you in order • After TABOR was passed, Colo- Washington families. Vote NO on I-1033. to advocate on your behalf. Please rado’s proportion of low-income take a moment to fill out the Rest children without health insurance Breaks & Overtime Survey! ➽ doubled. In other states, more kids were getting health insurance. To find out more info, Research confirms what we already donate or volunteer, visit: know from our own experiences; www.no1033.org nurses working long hours leads to decreased alertness, vigilance, concentration, judgment, mood, and performance.

Nurses’ ability to maintain the mental and physical alertness and focus required to provide safe and quality insurance through the Public Employees • Both partners are legally capable of patient care is dependent on: Benefit Board. consenting to the domestic partnership Registered domestic partners must meet The ability to take full, uninter- certain criteria to obtain these rights. All Vote ‘Approve’ on R-71 to protect rupted rest breaks same-sex couples and any different-sex domestic partnerships and ensure that couples with at least one partner aged 62 all families, in all parts of the state, will be Closing loopholes in the manda- or older can register as domestic partners treated fairly, with the same protections tory overtime law if: and responsibilities. This is a top priority for WSNA and • Both partners are at least 18 years old will be the focus of our legislative ➽ • Both partners share a common agenda during the 2010 Legislative residence To find out more info, Session. We need to hear from you! donate or volunteer, visit: Please take a moment today to fill • Neither partner is married or a state www.approvereferendum71.org out the survey. registered domestic partner with another person ➽ • The partners are not close blood rela- tives, and wsna.org/missedbreaksurvey

The Washington Nurse | Fall 2009 | 21 Legislative Affairs | Journey for Health Care Reform

From Washington State to Washington, D.C. MyJourney in Support of Health Care Reform

By Kim Armstrong, BSN, RN

arly one morning, I received a very special invitation. Presi- dent Obama was holding a press conference on health care as a follow up to his joint Congressional address. And he wanted registered nurses to be there! The call went out and I got a phone call from ANA asking me if I could attend. EMy initial reaction was of course I will! The opportunity to be in the same room as a seated President is something that does not come around often. Then reality set in—the cost of a last minute plane fare, housing and food. It seemed insurmountable. And I declined. After I hung up the phone, I was agitated. What an opportunity and I was going to miss it! I talked to my best friend who said, “You’ve got to do it, think of a way.” I went online, put calls out and—well, all I can say is, saving those frequent flyer miles for a rainy day was a good idea. This was my Rainy Day! With help, I arranged a roommate to cut housing expenses, used the subway and I was prepared to go at minimal expense. When President Obama appeared through the door, it was I arrived in Washington, after a 5 hour plus flight, at 10 PM to rousing applause. He greeted the four nurses on the stage and arrived at the hotel around midnight. Riding the subway warmly, and I immediately felt that even though I was in the at that time of night and walking the streets of DC is an experi- presence of the most powerful man in the United States, he was ence—but that is another story. My pre-arranged roommate, also genuine. As he spoke, he complimented nurses on their Marie Garwood, President of the Wisconsin Nurses Association, strengths and asked us—the nurses, because of our knowledge waited up for me. We both fell into bed exhausted, but I was too of the health care system – to not only support reform, but to excited to sleep. actively encourage it with our colleagues, friends, in our commu- We were up early the next morning and after breakfast walked nities, and with our elected officials. He quoted by name, a blog to the Eisenhower Executive Office Building. Like so many other he had read by Staff Nurse, Theresa Stone, from Pennsylvania, buildings from that era, it is under reconstruction, but the scaf- as she told the story of a patient who thought he had planned folding could not take away from the grandeur and stature of well for retirement, until he was diagnosed with leukemia. His this remarkable building. There, nurses from across America retirement was gone—wiped out by medical bills, and this man gathered in an auditorium. There was hustle and bustle as news instead of fighting his disease, was worried about how to pay reporters set up the cameras and audio equipment. The crowd for it. “This is why we need heath care reform,” said President was talking in anticipatory tones. The atmosphere was electric. Obama. Every nurse in the room was excited. Every nurse in the room Being in the presence of this man, I was greatly impressed that was waiting and we didn’t have to wait for long. even though his position put him in the place to be accountable Suddenly, a whisper went through the crowd and everyone for successes and failures, he realized changes could not be made became hushed. Secret Service personnel swept in and around alone. He was humble and respectful as he asked for nurses’ help the room. ANA President Rebecca Patton, came to the podium to push the health care reform agenda. One of the statements he and spoke for a few minutes, reiterating nurses’ perspectives made resonates with me—that the present cost of health care is on health care reform. She then introduced the President of the largest single contributor to our national debt, and we must the United States. fix it. But as President Obama said, it will take all of us.

22 | The Washington Nurse | Fall 2009 February 8th, 2010 is Nurse Legislative And suddenly it was over. The President left. There were Day. We’ll be in picture taking opportunities with other nurses around the Presidential Seal, on the steps Olympia, making of the Eisenhower Executive Office Building, conversations held, and then the long plane sure that nurses’ trip home. I thought about a lot of things voices are heard. on that flight home. I kept asking myself, why health care reform is so important and why now? The answer was all around me. Health care reform is for the young mother in our Join us. state who after three months of postpartum care, when her wound was still not completely healed, is forced to use duct (More information at www.wsna.org) tape from the garage to close the incision. It is for the small business owner without insurance, who makes too much to qualify for assistance, and is then expected to pay ‘full price’ when billed for procedures. It is for the nurse who needs a knee replacement and now is diagnosed with a cardiac condition. She has disability, but cannot use it because it would mean the loss of present medical coverage. Even if new medical insurance was available, would it cover preexisting conditions? YES: We Need Health Care Reform And We Need It NOW. I came away from the DC press conference with a sense of hope for the future of health care in the United States. I don’t know what reform will look like and I don’t think it will be the final product, but I do believe, as does ANA, WSNA and the Presi- dent of the United States, that the time is now and we must take this opportunity of a lifetime, during the lifetime of the opportunity, to see that it is done. President Obama, by making health care reform a priority for his administration, has created this opportunity.

The Washington Nurse | Fall 2009 | 23 Legislative Affairs | Nurses4HealthReform.org

WSNA Launches New Campaign

■ Visit Nurses4HealthReform.org to see televised ads, download the fact sheet which appears on facing page, or to email your legislators regarding health care reform.

s registered nurses, we advocate for our patients every The campaign is built around four major priorities for health day. Now we must stand together to advocate for all care reform: quality care for all, a focus on prevention, a strong A patients through meaningful health care reform. WSNA public option, and a robust nursing workforce. High costs and has always been proud to support the goal of quality, afford- lack of access – for both insured and uninsured people – are able health care for all. With health care reform as the main forcing too many people to wait until their health is in serious issue facing Congress this year, WSNA is fully embracing our jeopardy before seeking treatment. Everyone must have access responsibility to be leaders in educating our fellow nurses, the to primary care, public health, and regular, preventive medical public and elected officials about the critical need for reform and services so they can live healthier lives and prevent more serious nurses’ priorities for a new system. health problems. Providing timely and appropriate preventive care will always be our best and most cost effective health care WSNA is pleased to announce the launch of our new campaign, solution. Nurses4HealthReform.org, which has also been endorsed by the Oregon Nurses Association and the Montana Nurses Associa- As you know, WSNA and ANA have a long-standing history tion. The goal of the campaign is to bring the unique experiences of support for universal access to quality and affordable health and perspectives of registered nurses to the forefront of the care. This was reaffirmed by our members in a 2007 Resolution health care debate. approved by the WSNA General Assembly in support for Uni- versal Access and Health Care Reform. The resolution specifi- The campaign features: cally directed WSNA to: • Two television ads • Support legislative and policy efforts toward achieving throughout Washing- universal access to safe, quality affordable health care for ton State on North- all Washingtonians. west Cable News from August 19 through • Develop strategies and partnerships that challenge legis- September 18, reach- lators, policy makers, employers and the public to place ing more than 2 million a higher priority on providing comprehensive health people. View the TV ads insurance coverage and access to safe, quality health care on the new website. services for all Washingtonians at an affordable price. • The new website Nurses4HealthReform.org, to educate • Continue to strongly advocate for consumer access to a the public about the need for health reform and nurs- full range of health provider and health care services that ing’s priorities including facts and information on health include registered nurses as providers. reform, debunking myths about reform, tools for you to take action, as well as personal stories from nurses about why we need reform.

24 | The Washington Nurse | Fall 2009 Quality, Affordable Health Care for All.

As registered nurses, we advocate for our patients every day. We also see the devastating effects of our broken health care system.Today, we are standing together to advocate for all patients – we must have meaningful health care reform and we must have it now!

Skyrocketing costs, increasing numbers of uninsured and underinsured individuals and an overburdened public health system affect all of us – every income level, every ethnicity, every age and every region of this country.

Stay informed. Get the facts.

QUALITY CARE PUBLIC OPTION Health care reform must create a system that guarantees everyone A high-quality public insurance option, administered by the federal has timely access to: government, will drive costs down and keep insurance companies honest. • Quality care • In a convenient setting A public plan will: • By the most appropriate health care provider • Increase coverage • At an affordable cost • Create more competition • Let you choose between a public plan or PREVENTION keeping the insurance you already have • Negotiate savings from drug and medical equipment companies We know that providing timely and appropriate preventive care will always be our best and most cost effective health care solution. People must have access to primary care, public health, and regular, preven- NURSING WORKFORCE tive medical services. Without well-trained nurses to provide care, the growing nursing That means: shortage in this country threatens to derail any health care reform.

• Regular check-ups and screenings We must ensure: • Early treatment • An adequate supply of registered nurses • Better health • Increased funding for nursing education programs • Lower costs for all of us • Distribution and utilization of RNs to support preventive care • Use of advanced registered nurse practitioners (ARNPs) to provide primary care

Stay informed. Get the facts. Go to Nurses4HealthReform.org Labor Relations

WSNA Successfully Fights to Protect Our Members County Ordered Not to Disclose Nurses’ PERSONAL Information to Inmate

 On Friday, August 29, 2009, a Superior Court judge granted WSNA’s motion for a preliminary injunction, ordering the County to refrain from disclosing the names of Jail Health Services employees to an inmate seeking their disclosure under the Washington State Public Records Act.

This summer, King County Jail Judge Michael Fox granted WSNA’s inmate Joel Zellmer, who is await- motion for a preliminary injunction, ing trial for first degree murder in prohibiting the County from disclos- the matter of the death of his 3-year ing the names to Mr. Zellmer. The old stepdaughter, requested the order protects not only nursing full names, job titles and duties of staff, but non-nurse staff as well. WSNA Holds King County correctional employees, The Court found – and WSNA and ‘Sidewalk Social’ at UWMC including Jail Health Services (JHS) the County agreed – that the per- staff. JHS employees were notified sonal safety concerns raised by the any thanks go to everyone who came by and of this request by the County on July nurses who testified applied to all contributed to WSNA's "Sidewalk Social" 22nd. Upon learning of this, WSNA JHS employees. M event at University of Washington Medical Center took immediate action. WSNA Gen- The order will remain in effect until (UWMC) on September 3, 2009. Beginning at 5:00 am, eral Counsel Tim Sears, working next year, at which time WSNA’s WSNA members and staff took position on NE Pacific with WSNA Nurse Representa- lawsuit against King County is Avenue, directly in front of hospital, talking with tive Margaret Conley, sought and scheduled to go to trial. By that time, UWMC staff, forging new connections and making obtained a delay from the Health it is our hope that Mr. Zellmer will our presence known. Department. have been convicted and therefore It was a day of horn honks, words of thanks and On August 13th, in response to the be permanently ineligible under support, and also questions and conversations. County’s continued insistence that state law to receive this type of Address cards were filled out, WSNA literature state law required the release of JHS record. was distributed and membership applications employees’ names to Mr. Zellmer, Without the direct involvement were taken. The event lasted throughout the WSNA filed suit. On the following of our members, WSNA’s efforts entire day, ending at 8:15 pm. The UWMC nurses day, WSNA’s legal team obtained to protect the JHS nurses’ privacy repeatedly thanked their Local Unit leadership a temporary restraining order pre- and safety might not have been and WSNA Nurse Representatives and Organizers venting the County from disclos- as successful. WSNA continually for being there for them. Many of the non-nursing ing and releasing the names. Two seeks the involvement and input of staff who came by commented that they “wished nurses came forward and provided all our members. We know that it their unions would do stuff like this too.” anonymous testimony to the court, is our members’ voices that give us explaining the challenges of work- Everyone involved left feeling a terrific sense of our strength. ing for JHS, as well as some specific solidarity. Thanks to everyone who stopped by to safety concerns particular to Mr. Please continue to send questions, converse with colleagues, express their gratitude concerns, ideas and comments to us at Zellmer. [email protected]. and extend support. The feeling of teamwork and dedication was incredible. The event was a great success.

26 | The Washington Nurse | Fall 2009 Protecting Nurses Privacy • "Sidewalk Social" • Mandatory Vaccination

VM Forced to Retract WSNA Seeks Injunction in Federal its Mandatory H1N1 Court to Block Mandatory Vaccination Vaccination for RNs Policy by MultiCare Health System

Virginia Mason issued a press release to he Washington State Nurses Asso- “MultiCare’s unilateral implementation of the media (without any notification to its ciation filed a lawsuit in federal this policy blatantly ignores their legal nurses or WSNA – in violation of a 9th T court against MultiCare Health obligation to bargain with the union. Circuit Court mandate) on the afternoon Systems for unilaterally implementing a Their refusal to bargain and to cease and of October 1st stating that it will require mandatory vaccination policy. This new desist forced us to take this extraordi- all staff to receive the H1N1 vaccine as a policy will force nurses to get the flu vac- nary measure to seek relief from federal fitness-for-duty requirement. cination or to wear face masks as a condi- court. Nurses want to be part of the solution of employment and may result in the tion and participate in efforts to prevent When the media brought this to our firing of nurses who do not comply with the spread of flu this fall. We have real attention, WSNA immediately pointed the policy. The lawsuit seeks an injunc- concerns about how this program will be out that Virginia Mason defied the 9th tion to prevent the implementation of implemented and whether it actually pro- Circuit Court decision with its intention this policy for registered nurses at both motes the safety of nurses and patients,” to implement a new requirement of H1N1 Tacoma General and Good Samaritan said Barbara Frye, BSN, RN, Assistant vaccination as a fitness-for-duty. This is a Hospital. Executive Director of Labor Relations for change in working conditions and must WSNA. be bargained with WSNA, which they WSNA is advocating for an aggressive clearly have not done. voluntary vaccination program and an MultiCare’s proposed plan will give increase in other critical precautions to vaccinated nurses a special red badge Due to pressure from WSNA, Virginia prevent the transmission of the seasonal while requiring unvaccinated nurses to Mason has since issued a retraction stat- and H1N1 flu. WSNA was in the midst wear a surgical mask at all times while ing that the mandatory vaccination pol- of negotiating a flu prevention program on duty. WSNA has expressed concern icy did not apply to RNs represented by when they learned from the nurses that about MultiCare’s insistence on the use WSNA but those who don’t get vaccinated MultiCare had unilaterally implemented of masks despite a lack of research sup- will have to wear a mask at all times while a mandatory vaccination policy. porting their efficacy in the prevention of on duty. influenza transmission. This is a clear victory for WSNA nurses at Virginia Mason and around the State!

 Additional insight For WSNA’s position regarding flu vaccines, see page 11

For the most up-do-date, in-depth information regarding influenza and influenza vaccine, b visit www.wsna.org/flu

The Washington Nurse | Fall 2009 | 27 Labor Relations | 2009 Leadership Conference

Leadership Conference

ow in its 20th year, the WSNA N Economic and General Wel- fare Leadership Conference was once again a fun and educational event for nurses across the state. From September 27th to Septem- ber 30th, learning, networking and socializing all blended together at beautiful Lake Chelan. Presenta- tions included research on nursing workflow and technology; preparing for negotiations; photos and stories from WSNA staff and members who walked the picket lines during the 2007 Kentucky nurses strike; and a spirited closing presentation from Barbara Crane, RN, Presi- dent of the National Federation of Nurses – our new national union. Attendees left the 2009 Leader- ship Conference recharged and energized to get back to work with their Local Units.

As always, the highlight of the Con- ference was the E&GW Awards Banquet, where outstanding nurses are honored for represent- ing WSNA and their fellow nurses in their Local Units. Campbell’s Resort was transformed into the Hawaiian tropics with leis, tiki torches and coconut shells. Attend- ees danced to the Latin sounds of 2009 E&GW Leadership Conference Charanga Danzón, featuring WSNA member (and E&GW Award winner) Jim O'Halloran on flute. The Cabinet on Economic and General Under the Welfare presented its 2009 Local Unit Awards, with a special award recognizing the leadership, impact Tropical and dedication of WSNA Assistant Executive Director of Labor Rela- tions Barbara Frye, BSN, RN. Sun

28 | The Washington Nurse | Fall 2009  On the evening of Monday, September 28th, Campbell’s Resort was transformed into the Hawaiian tropics with leis, tiki torches and coconut shells. Attendees danced to the Latin sounds of Charanga Danzón, featuring WSNA member (and E&GW Award winner) Jim O'Halloran on flute.

The Washington Nurse | Fall 2009 | 29 Labor Relations | 2009 Leadership Conference

2009 E&GW Leadership Conference E&GW Awards  Every year, the Cabinet on Economic and General Welfare gives out special awards at the annual Leadership Conference to recognize and honor the WSNA leaders who have worked tirelessly on behalf of registered nurses in their Local Units, as well as throughout the state. Now in its seventh year, the E&GW Leadership Awards Banquet was again an inspiring evening filled with heartfelt gratitude for the contributions that each award winner has made. PeaceHealth Lower Columbia Region Nurses, and Martha Avey (right) Outstanding Local Unit Grievance Officer Award Cathy Sanders Northwest Hospital Cathy is described by her co-workers as being an amazing grievance officer at Northwest Hospital. She is focused on working with nurses and being a grievance officer who is knowledgeable, responsive to nurses needs, and dedicated to enforcing the contract on a day-to-day basis. Cathy goes above and beyond the call of duty in so many ways, spending endless hours both after work and on her days off to ensure registered nurses are Barbara Bly (left) with Peggy Slider represented at the time they need someone the Evelyn Street Susan M. Jacobson most. Outstanding Local Unit Chair Award Local Unit Barbara Bly Snohomish Health District Adversity Award Barbara is the Chair of her Local Unit and Sonya Miller Tacoma General Hospital consistently inspires other members to become Sonya has served as a Local Unit Officer for four involved with WSNA. She has also become very different terms of office and is currently serving engaged in the “Save Public Health” movement, as Local Unit Treasurer. Her job as a STAT nurse attending Board of Health meetings to find out gives her great visibility and contact with many about potential budget and staff cuts, speaking at nurses. This visibility also makes her the target of several evening community meetings, attending unhappy nurses. In spite of adverse conditions and conferences and conference calls sponsored sometimes dealing with confrontational people, by WSNA, and never stopping in her efforts to she chooses to be involved and do her best to make Cathy Sanders with Pam Newsom educated everyone about the public health crisis. our jobs safer, promote safe patient care, and to improve our working conditions. Outstanding Local Unit Chair Award Outstanding Local Evelyn Street St. Clare Hospital Unit Star Award Evelyn is an outstanding Local Unit Chair, who Susan M. Jacobson St. Clare Hospital never falters, no matter what challenges she Sue has stepped into her role as the new grievance faces. She has been local unit co-chair for many officer at St. Clare Hospital with the same courage years and stays on top of all the issues facing the and obvious dedication to the role as she nurses at St. Clare Hospital so that she can lead in demonstrated as the Local Unit Chair. The hospital the best possible directions. She expertly handles has had a record number of grievances and record her duties while also displaying an unprecedented number of complicated disciplinary issues the commitment to mentoring others within the Local past year. Her quiet confidence and dedication Unit. has inspired new Local Unit officers and her ability Sonya Miller to support and mentor these new nurses is widely known and respected.

30 | The Washington Nurse | Fall 2009 Outstanding Local Unit Negotiation Team Award PeaceHealth Lower Columbia The Washington State Nurses Negotiating Team Association wishes to thank the By late 2008, the PeaceHealth, LCR Negotiating following organizations for their Team had battled through eight sessions of support of the 2009 E&GW negotiations and had successfully obtained a great Leadership Conference: economic package – 12.5% over the coming three years. The team worked tirelessly, insisted on – and won – no take-aways in the contract. They also Sponsors successfully fought off a management generated MOU which would have forced nurses to cross- Sally Herman Jim O'Halloran Seattle Children’s Hospital train and float between Emergency Department & Medical Center and CCU. The Negotiating Team was always there, always ready, and doggedly persistent in their Frank Doolittle Company determination to get the best contract possible for the nurses of PeaceHealth, LCR. Pierce County Nurses Association Service Printing Outstanding Local Unit Membership Award St. Clare Hospital Local Unit Jim O’Halloran King County Nurses Association Virginia Mason Medical Center Peace Health Lower For years, Jim has worked tirelessly to increase Local Unit membership and encourage new hires Columbia Local Unit to join WSNA. He is consistent in his work to reach Barbara Frye out to every single new nurse that walks through Schwerin Campbell Barnard the doors at Virginia Mason Hospital. Jim has a Iglitzin & Lavitt LL wonderful way of connecting with nurses at new Hire Orientation and gives great examples of how Kadlec Regional Medical Center the union can protect your job when endangered Outstanding Labor at the job site and how the union negotiates your Program Director benefits and wages. Leadership Award Vendors Barbara Frye Capella University Emeritus Award From a very young age Barbara Frye wanted to be Electrocom Sally Herman a nurse. She collected books about nurses (Cherry Ames, Sue Barton) and even began working as a SeneGence International Sally has always been active in WSNA. She was very nurse’s aide during high school. After working as a active in her Local Unit for years until she retired staff nurse and nurse manager in Oregon for many Sightlife and N.W. Tissue Services from work, but she has never retired from WSNA. years and being very active in the Oregon Nurses Sally has been a mentor to so many nurses within Association, Barbara moved to Seattle in 1987. University of Washington Bothell our organization for so many years. Since retiring She soon made contact with WSNA, looking to once Sally has continued her dedication to WSNA by Grand Canyon University serving on the Board of WSNA and as a member again find ways to making a difference for nurses. It did not take long for WSNA to recognize Barbara’s of the Washington State Nurses Association Oregon Health & Foundation. We thank Sally for all her years of experience and potential, and she was hired as a commitment to WSNA’s mission and values and for Nurse Representative in 1990. She was one of three Sciences University her unbelievable and much appreciated dedication nurse reps for the entire state and Barbara worked to WSNA. with nurses in almost all of the WSNA units during World Medical Equipment those early years. In 1998, Barbara was promoted to Assistant Executive Director of Labor Relations Metlife where she continues today. Walden University As a mentor and a friend for many, Barbara’s leadership and guidance over the years is WA State Department Of appreciated and recognized by all. She is a truly dedicated advocate for nurses and the nursing Labor & Industries profession.

The Washington Nurse | Fall 2009 | 31 Nursing Practice Protecting Yourself Financially

"Like so many other nurses I know, I means you’d be solely responsible if you How thought that lawsuits only happened committed a negligent act and someone to other people. But when a uniformed was harmed. Professional deputy rang my doorbell and handed Contrary to what you’ve been Liability over a 25-paragraph complaint against told, having your own insurance me, I was devastated. The first thing doesn’t make you a more likely target for a lawsuit. Insurance that caught my eye was a notice that I Protects You had the right to designate the $4,000 But if you’re sued for malpractice, it’ll worth of assets that could be taken protect you financially by paying for your defense and any settlement or judg- to satisfy a settlement. The person ment against you (up to the limits of your by Kate Mager suing me could take my car, my jewelry, policy). Your risk manager, though, may Association Manager, Nurses Service Organization savings, and even a percentage of my tell you that you’re taking a bigger risk future wages if he won this lawsuit... " if you have insurance. But the patient’s — Excerpt from a letter (J.G., Tennessee) lawyer doesn’t know whether or not you have your own professional liability insurance when he names you in a law- rom time to time, Nurses Service suit. He won’t find out—in fact, he isn’t Organization (NSO) receives let- permitted to find out—about insurance ters from policyholders who want until the discovery phase of the lawsuit F to know whether they really need (which is when lawyers from both sides their professional liability insurance. examine relevant evidence and questions Colleagues, nurse-managers, even hos- everyone involved in the case). pital risk managers have told them that Another thing to consider: Access to the a separate policy is unnecessary because courts is one of our basic rights, so anyone they’re covered by their employer’s policy. can sue anyone else for any reason. Even if Have you been hearing the same thing? you’ve done nothing wrong, you still have Maybe you’ve even been thinking it your- to mount a defense against a malpractice self. Before deciding that you don’t need lawsuit. That alone could cost thousands your coverage, consider these facts: of dollars—but it won’t cost you anything if you’re covered by CNA’s professional Your employer’s policy will liability insurance policy. cover you, but only to a point. If your institution has to make That policy is designed to fit the insti- a payment because of your tution’s needs and protect its interests, negligent action, it could which won’t always be the same as yours. turn around and sue you. In other words, the insurance carrier may well defend the institution more vigor- This rarely happens — institutions can’t ously than it would defend you. afford to alienate nurses — but it is possible. If your institution sues you for mal- Also, your employer’s policy covers your practice, its policy certainly won’t cover actions only when you’re at work. So if you. But a policy provided through NSO you give advice to a neighbor after hours would. or volunteer to work at a community event, you’d be on your own—and that

32 | The Washington Nurse | Fall 2009 ❱ HALL OF FAME NOMINATIONS

Deadline Extended! The 2010 wsna hall of fame awards What happened to the customer who in license protection cases, and some wrote to us? She called and talked with attorney fees can be more costly. A case The Washington State Nurses Associa- one of our claims representatives. Here’s involving a nurse who was brought tion continually seeks ways to encour- more of her letter: before the Board of Nursing for a medi- age all registered nurses to strive for cation error ended up being reimbursed for $10,000 at the close of the case. Imag- excellence in nursing. The WSNA Hall "The claims representative told me to ine the financial burden she would face if of Fame is only one of many projects send the document to her by express she did not have her professional liabil- developed by WSNA to support WSNA ity insurance policy through NSO. By mail; she would take care of the members who demonstrate the highest comparison, paying $98* a year for your rest. Within a week, someone from the own protection through NSO’s Profes- standards of their profession. Nashville office called and told me that sional Liability Insurance policy is much criteria: Each nominee must have a lawyer had been hired to represent more economical. me. My lawyer kept me informed of the demonstrated excellence in the areas CNA, the underwriter for the profes- of patient care, leadership, education, progress of the lawsuit from discovery sional liability insurance program through settlement — a process of 11 offered through NSO spends hundreds public service, nurse advocacy, heroism, months. " of thousands of dollars each year defend- patient advocacy or clinical practice and ing health care professionals who have for achievements that have affected the been sued. Claims against health care Since utilizing a professional liability health and/or social history of Wash- providers do happen. You don’t take insurance policy is unpredictable, there ington state through sustained, lifelong the chance with your home or car. Why is always a risk of being sued. The real- put your license or certification and your contributions. The nominees must have ity is that if a patient perceives she has assets at risk? been or currently hold membership in been injured and she perceives that this injury is the result of a nurse providing, WSNA. The nominee may be living or or failing to provide, professional services, deceased. that patient could sue. This doesn’t auto- *The NSO rate of insurance for registered nurses in matically mean that the nurse has been Please go to www.wsna.org for the most states negligent. It means that the patient per- award nomination form. Typed appli- This risk management information was provided by ceives negligence. If this happens and Nurses Service Organization (NSO), www.nso.com/ cations must be received by WSNA by you are sued, regardless of negligence, wsna, 1-800.247.1500. WSNA endorses the individual November 15, 2009 to be considered you will need to mount a defense. To do professional liability insurance policy administered so adequately, you will need to hire a through NSO and underwritten by American Casualty for the 2010 Award. Nominees will be lawyer. Without a professional liability Company of Reading, Pennsylvania, a CNA company. notified in January 2010. The award Reproduction without permission of the publisher is pro- insurance policy you will face paying out hibited. For questions, send an e-mail to [email protected] winners will be recognized by the of pocket expenses, and those expenses Association, family, friends and nursing can be costly. Keep in mind that attorneys will charge you for any action that they colleagues at the Hall of Fame Awards perform related to your case, not limited event to be held on March 18, 2010. to actual court defense. This can include research, phone calls, and sending faxes to you or on your behalf. ➽ One example is the costs for a disciplin- Find Nomination Forms ary defense claim. NSO reimburses attor- Online at www.wsna.org ney fees at an average of $150 per hour

The Washington Nurse | Fall 2009 | 33 ❱ CONTINUING EDUCATION CALENDAR

F. Virginia Mason Medical October 2009: November 2009: January 2010: Center Clinical Education Department Dialectical Behavior Thereapy Skills Training in Dialectical Join the Surgical Team - Pacific Intensive Training Course; Barb Vancislo, CNE Coordinato Behavior Therapy: The Lutheran University School of Continuing Nursing Education, Trainers: Jennifer Waltz, PhD, & Essentials; Behavioral Tech, LLC; Nursing; January 5 through Anthony DuBose, Psy.D; Malibu, G2-ED New Orleans, LA; November 2-3; February 2, 2010; Contact: A 1100 Ninth Avenue – G2-EDU CA; Part 1: October 19-23, 2009; Contact Hours: 12.5; Contact: info@ Seattle, WA 98101 Part II April 19-23, 2010; by Mental Health and the Older behavioraltech.org Adult: Common Issues and (206) 341-0122 application only; 65 contact hours; (206) 625-7279 fax Contact Behavioral Tech at info@ Diabetes Management for Care Strategies - Pacific Lutheran Primary Care Providers - Pacific University School of Nursing; [email protected] behavioraltech.org www.MyPlaceforCNE.com Lutheran University School of Friday, January 29, 2010, 12:30-4:30 Geriatric Pharmacology - Pacific Nursing; Thursday, November 5, pm - Fee: $ 69.00 - Contact Hours: G. American Association of Lutheran University School of 2009, 8:30 am – 4:30 pm - Fee: 3.8; Contact: A Heart Failure Nurses (AAHFN) Nursing; Friday, October 23, 2009, $119.00 - Contact Hours: 6.0; Heather Lush 8:30 am – 4:30 pm - Fee: $119.00 - Contact: A 731 S. Hwy 101, Suite 16 Contact Hours: 6.25; Contact: A Solano Beach, CA 92075 Dialectical Behavior Therapy: Contacts: (858) 345-1138 Dementia Care: The Tools You Updates to Emotion Regulation [email protected] Need to Make a Difference - Pacific and Crisis Survival Skills; Trainer: A. Pacific Lutheran University Lutheran University School of Marsha M. Linehan, Ph.D., School of Nursing Nursing; Friday, Oct. 23, 2009 , ABPP; Dearborn, MI; November Continuing Nursing Education 12:30-4:30 pm - Fee: $ 69.00 - 9-10, 2009; 12.5 contact hours; Terry Bennett, Program INDEPENDENT SELF STUDY COURSES: Contact Hours: 3.8; Contact: A Specialis Contact Behavioral Tech at info@ Adult Smoking Cessation: Contact Skills Training in Dialectical behavioraltech.org Tacoma, WA 98447 253-535-7683 or bennettl@ Hours: 2.0; Contact: www. Behavior Therapy: The Wound Management Update plu.edu nphealthcarefoundation.org Essentials; Behavioral Tech, LLC; 2009; University of Washington Fax: 253-535-7590 Milwaukee, WI; October 26 - 27; AIDS: Essential Information for the School of Nursing; Shoreline Conf., www.plu.edu/~ccnl/ Health Care Professional; Contact Contact Hours: 12.5; Contact: info@ Seattle, WA; November 12-13; behavioraltech.org B. Bellevue Community College Hours: 7.0; Fees: $55; Contact: D Contact Hours: 6.5-13.0; Contact: C Continuing Nursing Animal Assisted Therapy; Bellevue Five-Day Foundational DBT Education Getting Started in Occupational Community College; Fee: $49; Training Course; Trainer: Kathryn Health Sciences Education & Health; Morris Hospital & Contact: B Korslund, Ph.D, ABPP, & Ronda Healthcare Centers; Morris, IL; Wellness Institute Oswalt Reitz, Ph.D.; Denver, November 13; Fee: $310/$350; 3000 Landerholm Circle SE Assessing Lung Sounds; Contact Bellevue, WA 98007 CO; October 26-30, 2009 by Contact: Association of Hours: 2.0; Fee $10; Contact: E (425) 564-2012 application only; 33 contact hours; Occupational Health Professionals Asthma Management; Contact www.bcc.ctc.edu Contact Behavioral Tech at info@ in Healthcare at (800) 362-4347 or Hours: 8.0; Fee: $30; Contact: E behavioraltech.org C. University of Washington [email protected] Breaking the Cycle of Depression: Disney Institute Hidden School of Nursing Immediate Response: Essential Continuing Nursing Education Contact Hours: 14.0; Contact C Treasures; Community Health Skills for Urgent Clinical Box 359440 Concepts, Dallas, OR; October Breast Cancer Prevention for Rural Situations; University of Seattle, WA 98195-9440 Healthcare Professions; Contact 27, 2009; Contact Hours: Washington School of Nursing; 206-543-1047 3.0; Fee: $65.00; Contact: Hours: 1.5; Fee: -0-; Contact: Shoreline Conf., Seattle, WA; 206-543-6953 FAX www.nphealthcarefoundation.org CHCeffectingchangeseminar.tk November 17; Contact Hours: 7.0; [email protected] 32nd Annual Pacific NW Nat’l Contact: C www.uwcne.org Cardiology Concepts for Non- Cardiologists; Contact Hours: 18.75; Conference on Advanced D. Intercollegiate College of Practice in Primary & Acute Care; Nursing Fee: $425.00; Contact: Fiona Shannon (360) 297-1274 University of Washington School of December 2009: Washington State University Nursing; WA Conv. & Trade Center College of Nursing Clinical Assessment Pulmonary Seattle, WA; October 28-31; Contact Skills Training in Dialectical Professional Development Patient: Contact Hours: 4.0; Fee: Hours: 21.5; Fee: Various; Behavior Therapy: The 2917 W. Fort George Wright $20; Contact: E Drive Contact: C Essentials; Behavioral Tech, LLC; Clinical Pharmacology Series: SanFrancisco, CA; December 3-4; Spokane, WA 99224-5291 Dialectical Behavior Therapy: 509-324-7321 or 800-281-2589 Contact Hours: 7-8.0; Fee: Contact Hours: 12.5; Treating the Eating Disordered www.icne.wsu.edu $195/175*; Contact: C Client with Multiple Problems; Contact: [email protected] E. AdvanceMed Educational Congestive Heart Failure-Diagnosis Behavioral Tech, LLC; Minneapolis, Dialectical Behavior Therapy: Services & Treatment: Contact Hours: 6.0; MN; October 29 - 30; Treating Clients with Borderline 2777 Yulupa Ave., #213 Fee: $25; Contact: E Contact Hours: 12.5; Contact: Personality Disorder and Santa Rosa, CA 95405 Culture & End-of-Life Web-based [email protected] Substance Use Disorders; www.advancemed.com Educational Modules: Contact High Risk Food Care and The Behavioral Tech, LLC; Hartford, CT; December 3-4; Contact Hours: 12.5; Hours: 3.0; Fee: None; Contact: Older Adult; University of Mary Shelkey at (206) 713-5637 Washington School of Nursing; Contact: [email protected] Seattle, WA; Oct. 31, 2009; Contact Devices and Systolic Dysfunction: Hours: 6.0; Fee: $245; Contact: C What’s New? Contact Hours: 1.0; Fee: Free/Non-Member $10; Contact G

34 | The Washington Nurse | Fall 2009 Domestic Violence; Contact Hours: Management of Persistent Pain: Sleep Disorders: Contact Hours: Wound Academy-Course 3 Dressing 2.0; Contact: C Contact Hours: 1.8; Fee: 8.0; Fee: $30; Contact E Selection & Infection Tuition; Fee: Ethics Related to Nursing Practice; No Fee; Contact: Smoking Cessation: Contact Hours: $30; Contact Hours: 2.5; Contact C Contact Hours: 9; Fees: $200; www.nphealthcarefoundation.org 12.0; Fee $35; Contact E Wound Assessment and Contact: D Medical/Surgical Nursing 2008: Telephone Triage: Contact Hours: Documentation; Fee: $60; Contact Everyday Encounters: Review Course for Practice & 3; Fee: 24.00; Contact Wild Iris Hours: 2.0; Contact C Communication Skills for Certification: Contact Hours: 50; Medical Education Contact C Successful Triage; Contact Hours. Telephone Triage Trivia; Contact 1.4; Contact: Carol M. Stock & Metered Dose Inhaler Use: Contact Hours. 1.0; Contact: Carol M. Stock Contact the following Associates Hours: 3.0; Fee: $15; Contact E & Associates Independent Study provider for Frequent Heartburn; Contact New Telehealth Technology: The Pain Management Dilemma: specific course offerings: Hours: 1.0; Fee: No Fee; Contact: FnP Legal Risks & Call Center Benefits; Contact Hours: 1.5; Contact: Associates Contact Hours. 1.2; Contact: Carol www.nphealthcarefoundation.org Wild Iris Medical Education Ann Johnson, CEO Geriatric Health Promotion Lecture M. Stock & Associates Tubes & Drains Techniques, Tips & PO Box 257 Series: Contact Hours: 34.50 or 1.5; Nurse Grand Rounds; Contact: C Troubleshooting; Contact Hours: Comptche, CA 95427 Contact C OTC Advisor: Advancing 2.0; Contact: C (707) 937-0518 Geriatric Health Promotion Patient Self-Care: Contact University of Washington [email protected] http://www.nursingceu.com/ Workbook Series: Contact Hours: Hours: 17.0; Contact: www. Continuing Nursing Education; courses/218/index_nceu.html 40.0 or 4.0; Contact C nphealthcarefoundation.org Offers over 30 self-study courses; Hepatitis Case Studies; Contact Prescribe, Deny or Refer? Honing Contact C Nurse Practitioner Health care Foundation Hours: .5; Contact C Your Skills in Prescribing Scheduled Washington State: HIV/AIDS With Drugs: Contact Hours: 10.4; Fee: 2647 134th Ave NE Hepatitis Web Studies; Contact the KNOW Curriculum: Contact Bellevue, WA 98005 $155/140*; Contact C Hours: .5; Contact C Hours: 7; Fee 65.00; Contact: Wild (360) 297-1274 Health Assessment and Pulmonary Hygiene Techniques: Iris Medical Education [email protected] Documentation: Contact Hours: 20: Contact Hours: 6.0; Fee: $25; Wound Academy-Course 1 Wound Fees: $150; Contact: D Contact E Assessment & Preparation for HIV/AIDS Basic Education: Fee: RN Refresher Course; Fees: Theory: Healing; Fee: $40; Contact Hours: Various; Contact B $500; Health Assessment and Skills 4.3; Contact C Review: $500; Clinical Placement HIV/AIDS -6th Edition Implication Wound Academy-Course 2 Lower for Precept Clinical Experience: Extremities and Pressure for Ulcers; for Nurses and Other Health Care $400; Contact: D Providers: Contact Hours: 7.0; Fee: $60; Contact Hours: 6.8; Contact C Contact C IMPACT: Web-Based Training in Evidence Based Depression Care Management; Contact Hours: 12.4; Contact C CEARP Committee Legal Issues & Trends in Telephone Triage; Contact Hours. 1.2; Contact: Recruiting Carol M. Stock & Associates Legal Issues in Nursing; Contact Interested RNs Hours: 4.0; Fees: $120; Contact: D Functions of the Committee oping evaluations, designing cational activities meet the Legal Risks of Remote Triage; are to review and approve content) for adult learners; standards set by ANCC for Contact Hours. 1.0; Contact: Carol M. Stock & Associates continuing nursing educa- member of WSNA; time to continuing nursing educa- Lung Volume Reduction Surgery: tion activities, covering a review about two application. Contact Hours: 2.0; Fee: $10; range of topics, for approval tions a month; able to attend Approved CEARP applicants Contact E of contact hours from a two Continuing Education are encouraged to apply Managing Type 2 Diabetes: variety of applicants includ- Approval & Recognition Contact Hours: 1.5; Contact: given your expertise in coming hospitals, community Program Committee meet- www.nphealthcarefoundation.org pleting our applications. colleges, universities and ings, and participate in two commercial entities. 1.5-hour teleconferences each To learn more, contact Hilke Note to Continuing Nursing Education year. Volunteer yourself and Faber at 206.575.7979, ext. 3005, or Providers: The Washington State Criteria for appointment Nurses Association is accredited as a friend. This experience send email to [email protected]. include: masters degree in an approver of continuing nursing provides a valuable needed education by the American Nurses nursing, previous experi- Credentialing Center’s Commission service to nurses in Wash- ence in successfully planning on Accreditation. If you wish to attain ington State. Your careful WSNA approval for an educational continuing nursing educa- evaluation of applications activity which you are providing to tion offerings (i.e., writing nurses, please go online to will help assure that edu- www.wsna.org/educations/cearp behavioral objectives, devel-

The Washington Nurse | Fall 2009 | 35 IN THE HEALTH CARE WORKPLACE – TRANSLATING KNOWLEDGE TO PREVENTION –

Opening Pandora’s Box: An Overview Running faster than the speed of life? Need of Workplace Violence to get some control back in your life?

Annie M. Bruck, MN, RN, COHN-S Lose your edginess & keep your edge… Stress management in a hurry Assistant Director, Continuing Education, Northwest Center of Occupational Health and Safety Mary Dean, PhD, RN Independent Consultant in Stress Management, trained at the Harvard Mind/Body Medical Institute Sticks and stones may break my bones, and words can sometimes hurt me… Revisiting Pandora’s Box: Solutions aimed Workplace bullying and lateral violence: What towards action and sustainable practice it is and what can be done about it Susan Johnson, MN,RN Sally Watkins, PhD, RN NIOSH Trainee for Occupational and Environmental Assistant Executive Director Nursing Practice, Education and Research, WSNA Health nursing program UW School of Nursing

BELLINGHAM SEATTLE/TACOMA YAKIMA SPOKANE October 12 October 22 November 11 November 19 5:00pm – 8:30pm 5:00pm – 8:30pm 5:00pm – 8:30pm 5:00pm – 8:30pm

Hotel Bellwether Doubletree Airport Hotel Clarion Hotel Red Lion River Inn One Bellwether Way 18740 International Boulevard 1507 N. First Street 201 W. North River Dr. Bellingham, WA 98225 Seattle, WA 98188 Yakima, WA 98901 Spokane, WA 99201

3.0 CONTACT HOURS WILL BE PROVIDED • FREE FOR WSNA MEMBERS / $20 FOR NON-MEMBERS • MEAL PROVIDED

– TO REGISTER, CALL IRENE MUELLER AT 206-575-7979, EXT. 0 –

Sponsored by: The Washington State Nurses Association Continuing Education Provider Program (OH-231, 9-1-2012) is • Washington State Nurses Association • Washington State Emergency an approved provider of continuing nursing education • WSNA Occupational & Environmental Nurses Association by the Ohio Nurses Association (OBN-001-91), an ac- Health & Safety Committee • Washington State University credited approver by the American Nurses Credentialing • WSNA Cabinet on Economic College of Nursing Center’s Commission on Accreditation & General Welfare • Northwest Organization • Northwest Center of Occupational Health of Nurse Executives and Safety, University of Washington • Washington State Hospital Association ❱ DISTRICT NEWS

King County Nurses Association Inland Empire Nurses Association District 2 News District 4

The King County Nurses Association is offering two evening seminars IENA’s annual Legislative Reception is scheduled for this fall. Each will be held from 6 – 9 p.m. at the Good Shepherd Center, October 13, 5:30 PM, at the Red Lion Hotel at the Park in 4649 Sunnyside Ave. N., in the Wallingford neighborhood of Seattle. Spokane. State and local legislators have been invited to Participants will receive 2.5 Nursing Education Credits. To register, please speak. What a wonderful opportunity for us to hear from visit the KCNA Web site at www.kcnurses.org. our Representatives and candidates running for office on healthcare issues in our communities. It is also a great opportunity to let them hear from us! This is a free event and Wednesday, November 11 Seasonal Affective Disorder: is presented with support from our Washington Association Thoughts on the Assessment & Treatment of "Winter Blues": of Nurse Anesthetists (WANA) colleagues. L. Dean Poppe, PhD, a self-employed psychologist and staff psychologist for United BackCare, Inc., will discuss Seasonal Affective Disorder (SAD), a type of depression that affects a If you would like to be notified of upcoming events please person during the same season each year. The workshop will send us your email address at [email protected] or submit focus on helping clinicians develop a better understanding of your email address via the link on our webpage at the multiple issues related to SAD, including the likelihood www.Spokanenurses.org of encountering the problem, the possible causes, approaches to assessment and diagnosis, how SAD differs from a major BOD elections were held in August, and we will have new depressive episode, and approaches to treatment, including faces joining our Board in November. New Directors-at-Large light therapy and psychotherapy. are Larry Koffel and Peggy Smith. Julie Thomsen will be our new Treasurer. We will have other new BOD members, as we The first seminar, Pandemic Influenza A H1N1: Preparing appoint volunteers to remaining Board positions. for the Second Wave, was held on Thursday, October 15th. Dr. Kay Koelemay, medical epidemiologist, Communicable Welcome to our new Administrative Secretary JoAnn Kaiser. Disease Epidemiology and Immunization Section, Public She will keep our office humming from 1200-1700, Monday- Health–Seattle & King County was the featured speaker. Thursday. JoAnn comes to us with a wealth of experience, KCNA also presented a conference earlier in the fall and we are thrilled to be sharing her with our WANA entitled "A Closer Look: Understanding Homelessness in colleagues. King County," on Saturday, October 3, 8 – 11:45 a.m. at the Shoreline Conference Center. The purpose of the program was to educate registered nurses, students, health care providers, and others about homelessness in King County.

To stay up to date on KCNA events and education opportunities, visit www.kcnurses.org. Hall of Fame SEATTLE MARCH 18, 2010

The Washington Nurse | Fall 2009 | 37 ❱ MEMBERSHIP UPDATE By Patrick McGraw

Frequently Asked Questions A sampling of the questions the membership department frequently receives via phone, fax or email:

Question: change of information card. Remember Question: How often does my employer deduct to check the boxes for installment and What happens if I leave the bargaining dues through payroll deduction? Visa or MC # on the application or card. unit but still want to remain a member? There is space available on the application Your employer may deduct dues once or When you leave the bargaining unit, you or card for you to provide the credit card twice per month. For further information, may still retain your WSNA membership information that will be used to charge please contact your employer's payroll at a reduced dues rate. Please complete a your dues. department. change of information card (which may be found on the WSNA Web site) to Question: indicate your employment status change. Question: The membership department can provide May I get a receipt for my dues payment? Can I receive another copy of information about payment options and my membership card? If you would like to receive a receipt for dues rates. payment of your dues, please contact the Yes, please confirm your address and you membership department by phone, fax will receive a new card in the mail. or email. Please confirm your mailing address and we will be happy to send a Question: receipt to you. What happens when I change employment

to another facility covered by WSNA?

Question: When you change employment to another Can dues be charged automatically Independent Contractor facility covered by WSNA collective to my credit card? Positions bargaining, you will need to submit a new For Registered Nurses Yes, installment dues can be charged application to WSNA. If employed by two Nurse Aide Evaluator automatically to your credit card. No facilities that are both covered by WSNA Position invoice would be mailed and the dues collective bargaining and paying dues via Administer examination for would be charged to a credit card once payroll deduction, you can choose which nurse assistant certification. every four months. To facilitate the facility you would like to deduct your dues. Part time, flexible schedule automatic payment process, please The total amount of your dues will be no working a few days per month. Positions are available complete a membership application or greater than the Category A monthly rate. throughout State. Minimum qualifications, current RN If you have questions, the membership department may be reached by phone at 206.575.7979, by fax license in good standing, at 206.838.3099 or by email at [email protected]. with one (1) year of verifiable experience caring for the elderly or chronically ill of any age. Excellent r e m i N d e r opportunities for retirees.

Membership Information & Employment Status Changes For more information, submit your resume to: It is the responsibility of each nurse to notify The Cabinet on Economic and General Welfare [email protected] the Washington State Nurses Association of any (CE&GW) policy states: When a nurse is on an change in work status which may include, but is unpaid leave of absence, the dues are adjusted not limited to: name, address, phone number, to the Reduced Membership Category during the Texas Nurses Association FTE increase or decrease, leave of absence, unpaid Leave of Absence period. The accumulated NACES Plus Foundation, Inc. medical leave, maternity leave, leaving or dues payment is to begin within 90 days of return 7600 Burnet Road Suite 440 Austin Texas 78757 joining a bargaining unit. This change must to work. The nurse will have up to twelve months www.nacesplus.org be done in writing either by using a Change of to complete payment of these dues. It is the Information Card or sending an email to wsna@ responsibility of the nurse to notify WSNA of wsna.org this change in work status.

38 | The Washington Nurse | Fall 2009 ❱ NEW MEMBERS

Whatcom County Mabry, Kayleen Ferrari, Deborah Spokane / Adams / Lincoln Lee, Aaron Bayes, Laura Martineau, Yvonne Fischer, Lorraine / Pend Oreille Nicholas, Sidim Cohen, Rebecca Mcdougall, Lindsey Garza, Coleen Elmore, Alysia Schiebler, Mindy Hallmark, Valerie Mcevoy, Amanda Gemma, Janice Evans, Mary Sharman, Barbara Hiemstra, Emily Mcfall, Teresa Gonzales, Nicole Harrison, Steven Tsubota, Tyson Husband, Jennifer Meyer, Robert Harmier, Krista Hill, Annemarie Wangchuk, Sonam Keenan, Alison Miller, Beth Helman, Courtney Johnson, Darryl Webber, Beth Moreland, Shawnee Mosby, Kristen Holterman, Kristi Malone, Tara Whitman County Ocegueda, Erin Moskwa, Ashlee Hsiao, Ming Chi Maxwell, Anissa Fisher, Marcy Nelsen, Cari Hudson, William Mehta, Abby King County Nelson, Cheryl Jewett, Juliet O'connor, Brett Benton / Franklin Aasheim, Fred O'leary, Colleen Jewett, Matthew Seurynck, Adele Abbott, Tanys Abrera-Uyehara, Ortiz, Eduardo Jones, Nicole Sharp, Katherine Anderson, Christina Stephanie Payne, Michael Jorgensen, Tracy Stirpe, Bruce Anderson, Jill Adams, Judith Pease, Julianne Kauzlaric, Ashley Thomas, Marcie Bybee, Joshua Allender, Amanda Pollard, Erin Lane, Marcia Tomlin, Holly Destito, Brenna Andrews, Scott Poniente, Geerhine Line, Laura Wendt, Nikki Gillilond, Greg Angell, Sovey Reichardt, Monica Long, Trudy Wintersteen-Arleth, Grant, Jennifer Barker, Jennifer Rueda, Dawna Lonzello, Sara Laura Kiefel, Jessica Barrett, Kelly Senger, Sally Ludwig, Mandy Zepeda, George Marion, Sylvia Beitz, Kathryn Solomos, Patricia Marnell, Christopher Mills, Nicole Beyer-Klayman, Amanda Steffes, Susanne Mccoy, Elizabeth Yakima City / N. Yakima Schatz, Nicole Blair, Elena Stephenson, Ann Messersmith, Eric Faussett, Dawn Blaylock, Cindy Lorraine Morris, Julia Mcginnis, Marlene Skagit / Island / San Juan Bowman, Kimberly Talge, Karen Nuismer, Jessie Rouse, Crystal Bates, Sarah Brandt, Becky Teferi, Kanna Ofori Amankwah, Hannah Wilson, Gordon Burgess, Susan Burt, Christine Thorson-Mador, Janet Phillips, Catherine Carty, Jeri Cantrell, Amy Trohimovich, Pamela Podolskaya, Marina Chelan / Douglas / Grant Cooney, Rachel Carandang, Rosheila Turner, Skylar Rimmereid, Lisa Bohart, Sharyl Demerjian, Melanie Carrico, Amanda Vanderweele, Mary Rivera, Merceda Collier, Kimberly Diaz, Falyn Chou, Li-Chieh Walker, Shawn Sally, John Harris, Carrie Epshtein, Lina Cross, Mary Walls, Brenda Schaefer, Shannon Hersel, Jamie Foxworth, Sari Crowell, Charles Whitney, Chelsea Scheler, Jessica Tull, Exxene Glanzer, Carrie Dubin, Rebecca Wilson, Wendy Schmuff, Heidiann Mancil, Jennifer Duong, Minh-Trang Wood, Tiffany Scott-Clark, Vicki Grays Harbor Moore, Carol Einfeld, Sophan Woods, Nancy Serbinenko, Vladimir Kinnison, Ardenella Parsley, Jeffrey Enriquez, Orlanda Zanker, Heidi Sheldon, Mariana Moffat, Susan Scott, Donna Feala, Michaela Zavaglia, Kerry Shmurun, Diana Rushing, Cameron Therien, Kathleen Garrett, Anne Zimmerman, Matthew Smith, Gabrielle Rushing, Laura Wean, Susan Golden, Elsa Smith, Mikayla Wehrman, Linda Grady, Erin Pierce County Straley, Paula Wahkiakum / Cowlitz Gray, Jamie Ahn, Aimee Timbers, Patricia Brandt, Kali Kitsap County Hedrick, Kelly Algara, Sherry Mae Walia, Tirath Dembinski, Karen Hamilton, Melinda Henriquez, Daniel Anderson, Lindsey Ward, Jolene Lentini, M. Kathleen Hunter, Keoka Atchison, Sarah Watson, Donna Pedersen, Zach Kittitas County Joyce, Kerry Bailey, Annette Zinck, Blane Fischer, Steven Kahler, Jennifer Barwick, Jeannie Clark / Skamania Henderson, Kara Kanno, Stephanie Bouma, Marcus Albershardt, Heather Kelly-Long, Dawn Brouillet, Kelli Ciecko, Amy All Other Counties Kowalik, Beata Cage, Ceciella Farrell, Gary Bucio-Martinez, Clara Layton, Kristy Cook, Marta Ferrazzano, Nina Elbert, Susan Lenz, Emily Cross, Alison Foster, Virginia Herndon, Evelyn Lewis, Wendy Curtis, Raymond Graham, Marie Laughner, Eleanor Linse, Carole Dean, Samielle Granger, Colleen Mayoh, Debra Lundstrom, Jamie Elmore, Mary Houlihan, Andrea

The Washington Nurse | Fall 2009 | 39 Washington State Nurses Association 575 Andover Park West, Suite 101 Nonprofit Org. Seattle, WA 98188 U.S. Postage Paid Seattle, Washington Permit No. 1282

February 8th, 2010 is Nurse Legislative Day. We’re going to raise a ruckus in Olympia. Join us.

(More information at www.wsna.org)