September 2007 Vol. 18, No. 3

FANNP HIGHLIGHTED: PHYSICIAN GROUPS VS. HOSPITALs: NNP WORK ENVIRONMENTS • VERMONT OXFORD iNICQ 2007 IMPROVEMENT COLLABORATIVE • TITLE PROTECTION FOR CLINICAL NURSE NEWS SPECIALISTS PLUS: POCKET NOTEBOOK • LEGISLATIVE UPDATE • EDUCATIONAL OFFERINGS

The Publication of the Association of Neonatal Nurse Practitioners

Neonatal Nursing Delegation People to People , May 2007

How about another experience of a lifetime! My goal was to seek knowledge of other nursing and NICU practice styles. What the differences and familiarities are in other cultures, and what works. Our group of 28 delegates consisted of four guests, NNPs and RNs. We landed in and reloaded for additional flights to Beijing, Guilin and . Now we have some flyer miles. In each city we met with nurses and exchanges at Beijing Children’s had six beds to a room. Mothers slept doctors to discuss topics of interest Hospital where we toured the facilities. in the beds with their children. They in each of our areas of expertise. We There were no labor and delivery remained in the hospital to take care visited numerous historical sites and facilities, so parents transported of their own children throughout the landmarks. The cities are bustling their infants if care was needed. stay. Fresh boiled water was brought with activity everywhere. There are so We discussed kangaroo care, infant by thermos to each room daily for many people millions of people, you development, infant swimming (this drinking. We shared information on will never lack for company. The large is done two times daily to improve kangaroo care, jaundice and prenatal cities have areas for children’s play circulation, intelligence and motor education provided by China. Prenatal and elderly walks. The hospitals and development). We made rounds classes are offered to entire families clinics are bombarded daily for health at Peoples Hospital, affiliated with once-a-week through out a four-week care and teaching. Children are highly Peking University, where we toured course; the class is always full. In the appreciated and, yes, there is still only a very warm humid hospital without newborn nursery there are six to ten a one child rule per family, but with air conditioning! The windows are babies per room per nurse. NICU many exceptions in this new day and opened twice daily for ventilation and does not allow visitation. In the units age. Few are abandoned because of netting is placed over because that we were allowed to visit we wore sex or anomalies, but abortions are a there are no screens on the windows. shoes covers, but there was not a hand form of birth control that is legal and The labor and delivery room, which washing policy. practiced. Prenatal care is highly looked allowed up to two deliveries at one In Guilin, we had professional upon by the entire family. time if needed, was clean and tidy with exchanges at the affiliated Hospital of In Beijing, capitol to China for outdated beds and radiant warmers. Guilin Medical College. We discussed over 850 years, we shared professional The children’s chemotherapy ward See “CHINA” on page 4 2

Message from the President

It is hard to believe half the year is already past. School is back in full swing. Holiday catalogs are arriving daily in the mail. Fall is here with October just around the corner… and that means one thing… conference and a “howling ghoul” time with the FANNP! THE FLORIDA ASSOCIATION OF Conference preparations are being finalized. This year, the conference planning NEONATAL NURSE PRACTITIONERS committee has outdone themselves again by developing a program that is “scary” BOARD OF DIRECTORS and challenging, and will expand your clinical and professional knowledge. Con- ference topics include “Stomach potion #9”; “NICU Masquerade”; “Nephron of Carol Botwinski, Largo, FL President Terror”…as you may have guessed we have a Halloween theme this year. It’s also during this time that the FANNP “loves” to give away money… and we’ll be doing Jacqui Hoffman, Seminole, FL it again this year with our scholarship program. At last year’s conference the FAN- President Elect NP awarded over $8,000 in scholarships. We also have research grants available for Deborah Fulop, Jacksonville, FL our members. Past President And, of course there will be ample opportunity to meet new friends, network, Kim Irvine, Land O’Lakes, FL and enjoy the Florida sun and beach. A Monster Mash is planned which will in- Secretary clude a beachside cookout and a live band. So come wearing your craziest or scariest Karen Theobald, St. Petersburg, FL costume or just come as you are... it will be great fun for all. Visit our website at Treasurer www.fannp.org to get all the information. MEMBERS AT LARGE I look forward to seeing each of you at the conference this October!

Terri Marin, Peachtree City, GA Carol Botwinski, EdD, ARNP Leslie Parker, Gainesville, FL FANNP President Diana Fuchs, Rockledge, FL Genieveve Cline, Clearwater, FL

Genieveve Cline Newsletter Editor Florida Coalition of Advanced Practice Nurses 1-800-74-FANNP • www.FANNP.org P.O. Box 14572, St. Petersburg, FL 33733-4572 Submitted by Paula Timoney, ARNP From the Florida Nurse, June 2007 — In March more than a dozen health care organizations met in Tallahassee to discuss health care issues. That two-day Kim Nolan Spirit Award meeting resulted in the establishment of the Florida Coalition of Advanced Practice Nurses (FCAPN). The primary mission of the coalition is to unify the efforts of all (KNSA) Update agencies representing advanced practice nurses, including nurse practitioners, nurse Kimberly Irvine, ARNP was anesthetists, and nurse midwives toward improving health care. The Coalition is awarded the Kim Nolan Spirit Award committed to creating and promoting creative solutions using advanced practice at the 17th National Neonatal Nurse nurses to address health care needs of all Floridians. Practitioner Symposium in Clearwater Representatives from the Florida Nurses Association, the Florida Nurse in October, 2006. Join us at this year’s Practitioner Network, Florida Association of Nurse Anesthetists, Colleges of Symposium as we honor a new winner! Nursing and other professional nursing associations were in attendance in To nominate someone for the Tallahassee. The co-chairs of the Florida Coalition of Advanced Practice Nurses Kim Nolan Spirit Award, go to the (FCAPN) are Christopher Saslo, DNS, ARNP, BC, President of the Florida Nurse website FANNP.org and download an Practitioner Network and Bonnie Marting, MSN, ARNP, BC, Florida Nurses application, or write to Paula Timoney, Association Director and District Liason. c/o FANNP, PO Box 14572, St. For more information, contact: Dr. Christopher Saslo at PO Box 17068, West Petersburg, FL 33733-4572. Palm Beach, FL 33416 or 561-676-2013, or www.flcapn.org 3

What’s up with the VON NICQ 2007 Improvement Collaborative? Submitted by Genny Cline, MSN, ARNP, RNC

The latest Vermont Oxford Neonatal Intensive Care Quality (NICQ) Improvement Collaborative began in January of 2007. This collaborative is comprised of interdisciplinary teams from 47 individual centers from North America. The teams are working collectively to improve the quality and safety of medical care for neonates and their Diagram of the model for the VON NICQ 2007 Collaborative (VON, 2007) families by focusing their efforts on seven important themes. The collaboration is coordinated by Kathy Leahy, NNP. as educational fairs to share their quality improvement Jeffrey D. Hobar, MD, Chief Executive and Scientific Officer experiences with the other members of the collaborative. of the VON, and co-leaders Margie Godfrey, Jim Handyside, Each center is connected with a “Learning and Improvement and Kathleen Iannacchino, are just some of the outstanding Community,” or a multi-hospital group that will focus on faculty leading this initiative. This accomplished group of specific NICU quality improvement processes. These multi- quality improvement facilitators and esteemed experts in the hospital groups will work together between the biannual area of quality and safety in health care will lead the teams meetings of the collaborative by staying in contact through throughout the collaborative. The program will also include conference calls and e-mail correspondence. a special leadership tract provided under the direction of At the completion of the collaborative the VON is Deb Miller. NICU leaders from participating centers will be planning to produce a resource kit for improving NICU meeting together for about a half hour prior to each of the processes related to the seven themes based on the work general meeting sessions to learn and apply new leadership developed by the participating centers. The resource kit will skills. include important case studies, useful strategies and tips, In an effort to improve the quality and safety of medical and trialed measurement ideas for addressing each of the care for neonates and their families all participating seven themes. For more information about the NICQ 2007 collaborative team members will focus on seven important Improvement Collaborative, contact Kathy Leahy, NICU central themes (see the diagram above). The seven themes Coordinator, her e-mail at VON is [email protected]. consist of family centered care, safe, effective, equitable, efficient, timely, and lastly socially and environmentally responsible. The first six themes were modified from the Institute of Medicine’ Aims, published originally in “Crossing the Quality Chasm: A Health System for the 21st FANNP Update: Century”, (IOM, 2001). The seventh theme, socially and 2007 Board and Officer election ballots have been environmentally responsible, was added by the VON for mailed. Please return your completed ballot in the NICQ 2007. Because family centered care is a major focus stamped, self-addressed envelope. of this collaborative, participating centers are encouraged to Your ballot must be postmarked by include family representatives on their teams and to include Sept. 30, 2007. them at the main meetings twice a year. Get involved! Volunteers are It is planned that during the collaborative, participating needed to help out with FANNP centers will meet face to face two times per year. At the committees. Contact FANNP; e-mail face to face meetings centers will participate in interactive addresses listed at FANNP.org. programs, small and large group training exercises, as well 4

CHINA continued from page 1

HIE/Asphyxia and information and ideas, and I developmental care of think “People to People” is a the NICU infants. We great organization with which had a great exchange to travel. I appreciated the of information and all FANNP helping to sponsor was presented well. We my trip, and allow me the then traveled to Peoples opportunity to share what I Hospital in Lingchuan learned with all our FANNP County, a community members and my associates. hospital with 218 It was a very interesting trip. Guess what! If you are over 40 in beds with OB/GYN, China, you don’t work night shift because you can’t see as well internal medicine and and need to rest more, but they still love us on days. outpatient care. Here With Sincere Appreciation we discussed PICC lines Deborah C. Fulop ARNP-C, MSN placed by trained nursing staff, PKU testing, hyperbilirubinemia and continued from page 8 blood drawing which is SCHOLARSHIP usually only done in FANNP National Neonatal Nurse Practitioner Symposium: morning by the physician or nurse. Patients usually stay 3-4 days Clinical Update and Review. following vaginal deliveries and 6-7 days post cesarean section. The FANNP Board of Directors will select the scholarship In Shanghai the professional discussions were held at recipients based upon these qualifications and the applicant’s First Maternity and Infant Health Hospital. First Maternity level of practice and educational and professional goals. The and Infant Health Hospital is a 272 bed hospital with 128 number and dollar amounts of the annual scholarships will mother/baby admissions and 1700 outpatients daily. This be determined by the FANNP BOD based upon the amount clinical treatment center and health care center is run by the of monies available in the scholarship fund, the number of government. They have 56% high risk deliveries. Dr. Hu applicants, and each applicant’s qualifications as listed here. spoke on asphyxia and we shared similar results and care. However, they are getting a late start on protocols for neonatal resuscitation with apgar scoring. We discussed SIDS and back to sleep technique which is widely used. Also of interest were nosocomial infections, Bring It On… handwashing protocols. Our visitation included “The Achieve Easy Housekeeping Practice Questions to Prepare for the Services” (certification in NNP Certification Exam housekeeping and maternal care and counseling, which 1. Subgaleal hemorrhage has been associated with: was initiated in 2005, a. Forceps use provides mothers with home b. Precipitous delivery care for 2-4 months on well c. Vacuum extraction babies and mothers). This service is paid for by the 2. The appropriate endotracheal tube diameter for a baby family. Mothers are allowed who weights 1500 grams is: 3-6 months and up to one a. 2.5 year off but without salary. b. 3.0 We can make a c. 3.5 difference by exchanging Answers on page 7 5

Working as an NNP for a Physician Group vs. Hospital Jacqueline L. Guzman, MSN, NNP Graduate

Whether they are new graduates or experienced neonatal The stability of the physician group or hospital is an nurse practitioners (NNPs), an increasing number of NNPs are important consideration when selecting an employer as a NNP. seeking employment in neonatal intensive care units (NICUs). The NNP’s contract may be dependent on the physician group Their actual employer can be either a physician group or the remaining the same, increasing in size, or maintaining their hospital itself. This article can be useful when evaluating the contract to provide services. As a hospital based NNP, work may decision to make an employment decision. also be dependent on acquisition of or downsizing of contracts. There are pros and cons about working in either a physician Some NNPs find themselves in a situation where they must group or the hospital itself. The NNP must evaluate several reapply to a physician group that has been awarded a contract factors before accepting an offer when a hospital does not renew like contracts and benefits, their contract. role, stability of the physical NNP advocacy is a concept group or hospital, advocacy, and that should be evaluated in compensation. depth. Some groups and When working for a hospitals do not have an physician group, the NNP signs administrator or a liaison that a contract and is considered to will respond to the rights, be serving as an independent needs, and concerns of NNPs. contractor or as an employee of NNP conflict, confusion, and the group. The contract outlines dissatisfaction can be caused the conditions of employment when the NNPs have no voice including: standards to which in administrative decision- the NNP will be held, roles making. and responsibilities of the Compensation is a major NNP, salary and benefit plan, factor of a NNP’s decision to stipulation for termination, scheduling, terms of malpractice accept a position. Some physician groups offer a non-negotiable insurance, predetermined financial compensation for paid time pay scale that includes financial compensation for previous NNP off and educational conferences. Hospital employed NNPs experience or credentials. While other groups base their pay scale may have better group benefits, including: health and liability on set criteria like: patient satisfaction scores, infection rates, insurance, paid time off, overtime pay, and shift differential often length of stay, and outcomes. As physician groups offer some offered to other hospital full-time employees. flexibility in financial advancement, hospital employed NNPs are The role of the NNP may differ from group to group or usually unable to bargain their pay, bonuses, or incentives. within a group when employed by a physician group. She may The NNP role was created in the 1970s as a result of serve as an expert clinician, educator, researcher, manager, leader, the increasing complexity of neonatal care needs, a desire by or a consultant. She may be responsible for the management neonatal nurses for more independence and a greater role in of the high-risk neonate’s clinical treatment, in conjunction caring for the critically ill infant, and decreases in resident with other members of the health care team. Depending on the availability to cover the NICU. Depending on the demographics, group she may or may not be responsible for attending high-risk the NNPs role can significantly differ. The cost-effective role deliveries and providing resuscitative measures. She may perform of the NNP will continue to broaden as hospitals make budget physical examinations; formulate appropriate diagnoses; develop cuts. It is important to know the differences between working treatment plan; order pharmalogical and nonpharmalogical for a physician group vs. a hospital as a NNP. It is these small agents; perform procedures; and order diagnostic tests. The differences that can influence your role, development, and hospital employed NNP may be required to comply with the happiness in your employment decision. The preceding factors same policies mandated for all nursing employees. It is important should be evaluated in depth before accepting a position as a to know whether you will be used to practice medicine or just to NNP in a hospital or physician group practice. replace medical residents. 6

Author’s Note: With the proliferation of nurse practitioner Title Protection for programs nationwide, educational programs for clinical nurse Clinical Nurse Specialist specialists decreased in number. Many nurse practitioners are in roles of and use the designation of clinical nurse specialist. Submitted by Paula Timoney, ARNP If you are an ARNP using the title CNS, you do not meet the The Florida State Legislature recently passed a bill effective criteria to do so in the state of Florida. In our institution we July 1, 2007 to provide title protection to “Clinical Nurse have changed the title to Advanced Practice Nurse. Specialist.” Most health care professionals upon quick review did not recognize the ramifications of the bill. Many questions were raised in deciding whether the Clinical Nurse Specialists in our facility met the eligibility requirements. I further clarified the criteria of the bill in a discussion with Rick Garcia, Executive Director of the Florida Board of Nursing on August 15. Educational Offerings 2007 The bill provides for title protection for certified clinical nurse specialists who meet the following criteria: 7th Annual National 18th Annual FANNP Neonatal Nurses Meeting Symposium and Clinical 1. Hold a current and active license as a registered nurse, September 5-8, 2007 Update 2. Have a Master’s or higher degree in nursing with credential Las Vegas, Nevada October 16-20, 2007 of CNS awarded, The Academy of Neonatal Clearwater, FL 3. Advanced Practice Registered Nurse-Board Certified in the Nursing and Neonatal Network FANNP nursing specialty as a clinical nurse specialist. www.neonatalnetwork.com or www.FANNP.org www.academyonline.org Three certifying bodies offer certification as a clinical nurse The Vermont Oxford specialist: 10th Anniversary National Network Annual Meeting 1. American Nurses Credentialing Center (ANCC) Mother Baby Nurses and Quality Congress for 2. American Association of Critical Care Nurses (AACN) Conference Neonatology September 5-8, 2007 December 1-2, 2007 3. Association of Oncology Nursing (AON) Las Vagas, Nevada Washington, D.C. The following subspecialties are available: Mother Baby Education and www.vtoxford.org 1. Diabetes Management Neonatal Network 2. Advanced Adult Health www.neonatalnetwork.com Hot Topics in Neonatology December 2-4, 2007 3. Child/Adolescent Psychiatric and Mental Health A Passion For Excellence Washington, D.C. 4. Psychiatric and Mental Health Creating Brighter www.hottopics.org 5. Gerontological Tomorrows For Babies 6. Pediatric 23rd Annual Educational 5th National Advanced 7. Public/Community Health Conference Practice Neonatal Nurses 8. Advanced Oncology Clinical Nurse Specialist September 26-29, 2007 Conference San Diego, California April 24-26, 2008 9. Certified Critical Care Nurse Specialist NANN Hyatt Regency Any nurse seeking certification as a clinical nurses www.NANN.org Miami, Florida specialist from the Florida Board of Nursing must apply to the 8th National Neonatal Department of Health and submit proof that he or she meets the Nurses Meeting criteria. Currently there is no application available. However, October 8-11, 2008 the process and application are being worked on. Marriot Wardman Park With an implementation date of July 1, 2007, all nurses Washington, DC currently using the designation of clinical nurse specialist must stop using the title. The BON will give a short period of time, three to six months for everyone to comply. Those who do not comply will be issued a “notice of non-compliance with statute.” From the BON website: the CNS will not be required to submit protocols. They will not have prescriptive authority and will not be able to work on a provisional license. For any questions, contact the BON at [email protected] 7

provide a sounding board for issues brought to congress related to nursing. It is anticipated this caucus will greatly benefit all Legislative nurses. Update Nursing has the opportunity to make huge changes in the current health care system. It is our duty as ARNPs to become familiar with the issues concerning our profession and to become Summer, 2007 active in our national and state organizations. Submitted by Leslie Parker, RNC, NNP MSN The 2007 Florida legislative session proved to be exciting, POCKET NOTEBOOK productive and filled with a number of important issues Diane McNerney ARNP, MS, RNC effecting advanced practice nursing. Bills potentially affecting ARNPs in the state of Florida included the following; Electrolyte Guide to Infant Formulas Senate Bill 248/House Bill 879 passed. This is a bill providing title protection for Certified Registered Nurse Formula Sodium/meq Calcium/Phosphorous Anesthetists, Certified Nurse Midwives, and Clinical Nurse Per Liter mg/per liter Specialists. It also provides licensure of Clinical Nurse Specialists. Human Milk Term 177 279/143/mg Senate Bill 1508/Senate Bill 469 also passed. This is a bill to Preterm 248 248/128/mg include ARNPs and PAs in the statue which provides certain Similac Advance 162 528/284 civil immunity to health care providers who obtain informed Similac Lactofree 203 568/379 consent. Similac 20 162 528/284 Senate Bill 1958/House Bill 1299 was a bill which would Isomil 298 710/507 allow ARNPs to certify the cause of death and sign death NeoSure 2 245 781/461 certificates. ARNPs would only be involved in certifying the SSC 20 291 1217/676 cause of death in uncomplicated and expected deaths such SSC 24 349 1461/812 as those occurring in a hospice or a long term care situation. Similac PM 60/40 162 379/189 Unfortunately this bill did not pass Similac Alimentum 298 710/507 Senate Bill 556/House Bill 1263 is the prescriptive privilege Enfamil/Fe 20 183 527/290.5 bill which would allow ARNPs to prescribe controlled Enfamil Lipil 183 527/358 substances, schedules III through IV. Unfortunately, once again this bill did not pass. Florida continues to be one of only Enfamil Lactofree Lipil 203 555/310.8 three states which do not allows ARNPs to prescribe controlled Enfami/Fel 24 219 633/290.5 substances. Enfamil AR Lipil 20 271 527/358 Enfamil ProSobee 20 243 710/466 On a national level, the American Nurses Association Political Action Committee (ANA-PAC) endorses candidates Enfamil Prosobee Lipil 243 710/466 who show support for the nursing profession. The last election EnfaCare Lipil 22 260 893/491 in November, 2006 represented the highest percentage of Enfamil Premature 20 392 1116/561 elections for candidates endorsed by ANA-PAC with a win Enfamil Premature 24 392 1116/561 rate of 89%. Please consider supporting representatives that Enfamil Pregestimil 20 318 778/507 support our profession. To find out who they are, please CGS Supreme 20 181 429/241 refer to the ANA web site at http://www.nursingworld.org/ MainMenuCategories/ANAPoliticalPower/ANAPAC.aspx To increase awareness of the issues concerning the nursing profession including the severe nursing shortage, Bring it On (questions on page 4)… Representatives Lois Capps (D-CA) and Steven LaTourette Answers (R-OH) have established a bi-partisan Congressional Nursing 1. Vacuum traction pulls and separates if not applied or Caucus. This Caucus will allow open forums to address manipulated correctly. C is the correct answer. nursing issues, serve as a clearinghouse for information and 2. 3.0 is the correct size for a 1500 gram infant. Florida Association members and then associate members. September 15, 2008.) of Neonatal Nurse Practitioners • Priority for scholarship award will be • An applicant may receive a maximum based on length of membership and of two scholarship awards for each 2007 Scholarship Application service to FANNP. degree sought. Eligibility Guidelines • You must be a licensed RN, ARNP, • Preference will be given to those FANNP was founded to support the NNP or equivalent. working towards a degree in neonatal educational advancement of Neonatal • Preference will be given to currently health care. Nurse Practitioners. To achieve this goal, licensed certificate NNPs working If awarded a scholarship, recipients each year on Dec. 31, at least 10% of the towards a NNP degree. agree to write a short article for the available monies in the general operating • You must attend an educational FANNP newsletter within the next year. budget are put in a scholarship fund. program leading to a degree related This year’s scholarship application to the health care field during the Guidelines for scholarship qualification are must be postmarked by Sept. 15, 2007; application period. as follows: 2008 scholarship applications must be • The application period for the 2008 postmarked by Sept. 15, 2008. • You must be a FANNP member. scholarship is September 15, 2007 to Scholarships of $500 – $1000 dollars • All members, student members and September 15, 2008. (i.e. To be per qualified applicant will be awarded associate members are eligible. eligible for a 2008 scholarship you each year at the FANNP Annual Business • Priority for scholarship award will be must have attended classes sometime meeting, scheduled in conjunction with given to members, followed by student between September 15, 2007 and See “SCHOLARSHIP” on page 4

The information in this newsletter is protected by copyright and may not be copied or transmitted without permission of the publisher. The information contained reflects the opinions of the authors and not necessarily those of the FANNP. While every effort is made to validate the information presented, FANNP makes no absolute guarantees as to the accuracy of the information within.

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