August 2017 • Volume 26 • Number 3 www.nvnurses.org Nevada RNFORMATION THE OFFICIAL PUBLICATION OF THE NEVADA NURSES ASSOCIATION The Nevada Nurses Association is a constituent member of the American Nurses Association Inside Quarterly publication direct mailed to approximately 37,000 Registered Nurses and Licensed Practical Nurses in Nevada articles 4 NNA/NONL Convention

4 Call for Posters

5 Legislative Session Summary NNA/NONL Convention: 6-7 Legislative Update Creating Our Vision 8-9 Future of Nursing in Nevada for the Future Awards Dinner Page 4 10 Check It Out!

10 NNA District 1 Report

11 Antibiotic Stewardship: Focus on Outpatient Prescriptions

12-13 State of the Air in Nevada 2017

14 The Stress Burden: Strategies for Future of Nursing in Nevada Management Awards Dinner Page 8 regular features 3 Message from President Dave Tyrell

Saturday, October 7th “Mad Hatter” Big Hat High Tea

State of the Air in Nevada – Report Card for 2017 Page 12

Details on page 15

Presort Standard US Postage PAID Permit #14 Mark Your Calendars Princeton, MN current resident or 55371 • July 29, 2017, Bleeding Control, Elko • October 7, 2017, Big Hat High Tea, Governor’s Mansion • November 30-December 1 NNA/NONL Joint Convention, Reno Page 2 • Nevada RNformation August, September, October 2017

Have you visited the NNA Job Board recently? NNA Mission Statement The Nevada Nurses Association promotes professional nursing Visit our website www.nvnurses.org and click on the Job Board practice through continuing education, community service, nursing tab to view many available Nevada nursing jobs. If you want to leadership, and legislative activities to advocate for improved health receive email notice when a new job is added, join our Job Board and high quality health care for citizens of Nevada. mailing list! Just send your email address by text message: NNA State Board of Directors Text NNAJOBBOARD to 22828 to get started Dave Tyrell, BSN, RN [email protected] ...... President or email [email protected]. Donna Miller, RN [email protected] ...... Vice-President If you have a job to advertise, contact Ian at Nicola Aaker, MSN, MPH, RN, CNOR, PHCNS-BC [email protected]. . Treasurer [email protected]. Our rates are reasonable and Bernadette Longo, PhD, RN [email protected] ...... Secretary money raised helps to benefit Nevada nursing. Heidi Johnston, MSN, RN, CNE [email protected]. . Director at Large Amy Pang, BSN, RN [email protected]...... Director at Large Peggy Lee, BSN, RN [email protected]. . . . . Director at Large www.nvnurses.org Julie Wagner, PhD, RN [email protected] . . . . President, District 1 Carl Bottorf, RN, MPA [email protected]. . . . President, District 3 Published by: Carol Swanson, DNP, RN [email protected]. . . . Legislative Chair Arthur L. Davis Publishing Agency, Inc. Editorial Board Editor: Margaret Curley, BSN, RN [email protected] s, we have been providing qua Las Vega lity care to tes from our co inu mmu John Buehler Garcia, RN, BSN Denise Rowe, MSN, RN, FNP-C 30 m nity just sin ted ce 1 Eliza J. Fountain, RN, BSN Kathy Ryan, MSN, RN-BC ca 93 Lo 1! Wallace J. Henkelman, Ed.D, MSN, RN Debra Toney, PhD, RN Mary Baker Mackenzie, MSN, RN Christy Apple Johnson, BSN, RN John Malek, PhD, MSN, FNP-C Val Wedler, MSN, RN Boulder City Hospital is about providing Quality Care Close to Home! Betty Razor, RN, BSN, CWOCN

Growth Potential Are you interested in submitting an article for publication in RNFormation? Please send it in a Word document to us at Competitive Wages Currently seeking experienced RN’s in: [email protected]. Our Editorial Board will review the article and notify you whether it has been accepted for publication. Articles Predictable Schedules Long Term Care (RN’s, Charge RN and MDS) Medical Surgical/ Tele • Surgical Service for our next edition are due by September 1, 2017. Comprehensive Benefits ER • Nursing Leadership including 403b and generous PTO If you wish to contact the author of an article published in RNFormation, please email us and we will be happy to forward your Contact us at: 702-293-4111 ext 533 or e-mail [email protected] • www.bchcares.org comments.

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Dave Tyrell, BSN, RN President, Nevada Nurses Association

“They may forget your name, but they will never forget how you made them feel.” –Maya Angelou

First of all I would like to once again send a sincere Thank You and Congratulations to all of the nurses who were recognized at the Future of Nevada Nurses and Northern Nevada Nurses of Achievement events held across the state in May. Also a HUGE thank you goes out to all of the people involved in making these events a reality. It is because of your tireless commitment to improving nursing in the state that makes these events possible and so much appreciated by all. On some of NNA’s other fronts, the Legislative committee continues to be an influential force behind bills focused on improving nursing’s ability to provide exceptional care for all patients in the state. Also, the Safe Staffing Task Force which grew out of the Safe Staffing meetings held earlier in the year has already met a couple of times. The group currently is focused on analyzing information summarized from the Safe Staffing meetings and coming up with action plans. We will keep you posted as the Task Force moves forward. Finally, please hold the dates of November 30, 2017 and December 1, 2017 on your busy schedules. This is when NNA and the Nevada Organization of Nurse Leaders will be holding our joint conference at the Grand Sierra Resort in Reno. Several committees are hard at work right now putting together the event which promises to be a must attend for all. Watch your email for more information on how to sign up to attend. You will not be disappointed.

 If you would like to contact NNA or President Tyrell, please call 775-747-2333 or email [email protected]

A Special Invitation To NNA Members: A Call to Serve

We invite you to be a candidate for office on one of the Boards of Directors in the Nevada Nurses Association. This is a way to share your ideas, work toward the realization of your personal and professional goals, and participate in shaping the future of health care in Nevada. Most terms of office are two years, and most business is conducted by email or teleconference. In Northern Nevada – District One – we are seeking candidates for Vice-President, Treasurer, and Director at Large (3). In Southern Nevada – District Three – we are seeking candidates for Secretary, Vice-President, and the Director at Large (1). At the state level we are seeking candidates for Secretary, Director at Large (1), and Nominating Committee. We need candidates for 2 ANA Member Assembly Delegates and two alternates. You must be a member of ANA/NNA and willing to travel to Washington, DC, in 2018. We will be happy to send you a summary of the office you’re interested in. If you’d like more information, please contact Margaret Curley at [email protected]. Nominations will close on September 28, so please begin to think about how you would like to participate. We welcome self-nominations. And thank you for serving the nurses and patients of Nevada – you are appreciated! Page 4 • Nevada RNformation August, September, October 2017

2017 Nevada Nurses Association/Nevada Organization of Nurse Leaders Convention Creating Our Vision for the Future

Scheduled sessions Call for Abstracts for REGISTER NOW! (subject to change): Poster Presentation Join nursing colleagues and nursing • Creating a culture of excellence NONL/NNA Conference students at the premier Nevada nursing • Nevada Staffing Initiative and November 30, Dec 1 convention of the year, which will be held Exemplars November 30-December 1 at the beautiful • f Care o LGBT patients Conference Title: Grand Sierra Resort in Reno. Take advantage • Corrections Nursing “Creating our Vision for the Future” of this great opportunity to earn CEUs while • Expanding Nevada’s Safe Staffing networking with Nevada nurses and vendors Initiative to rural hospital and LTCs Type and Categories of Posters from around the country. • Hot topics - Research Posters • Opioid Abuse - Case Presentation Poster Who should attend? All Registered • Future of Healthcare in Nevada: - Quality Improvement Poster Nurses and Nevada nursing students! ACA / Medicaid / ??? - Patient Safety/Satisfaction Poster • SBIRT (Screening, Brief Intervention Highlights include: and Referral to Treatment) Thirty posters will be presented during • Keynote Address by national speaker, Seun • Nurse Fatigue the NONL/NNA conference that will be held Ross • Antimicrobial Stewardship November 30 and Dec 1, 2017 in Reno, • o Up t 40 vendors! • Transition to Practice New Research Nevada. Abstracts will be used as the basis for • Poster presentations! • Succession Planning for the Coming selecting the poster for the presentation. • Multiple tracks! Nursing Shortage • Beautiful venue at the Grand Sierra Resort! • and more! Dates to be aware of: Abstract will be due: September 1. Join us on Thursday evening for a little Selection will be made by September 30th. entertainment open to the community, hosted Final Draft of PowerPoint Slide to committee by the Nevada Nurses Foundation, featuring for making copies for presentation: professional performers, plus “Nurses Got EmpRes Healthcare Management, LLC November 6th. Talent”! Conference participants will receive a discount for this event (Proceeds from Nurses HIR Each abstract should contain: W IN Got Talent help to support Nevada nursing Ormsby Post Acute Rehab O • Title and Author information Carson City G scholarships and professional development.) N • Introduction Gardnerville Health and Rehabilitation Center • Methods Where Gardnerville R • Results Grand Sierra Resort s Mountain View Health and N • Conclusion 2500 E 2nd St, Reno, NV 89502 Rehabilitation Center N • No more than 250 words Carson City s P & L VISIT OUR WEBSITE WWW.NVNURSES.ORG For more information, e-mail: [email protected]. Submit to [email protected] FOR MORE INFORMATION

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I.H.S. is required by law to give absolute preference to qualified Indian applicants. Equal Opportunity Employer. August, September, October 2017 Nevada RNformation • Page 5 Legislative Update 2017 Legislative Session Summary The 2017 Legislative Session is complete. The session finished, as include: forms for jury duty, certification of a expected, Tuesday morning, June 6, at 12:00 a.m. NNA had a very disability, exemption for a child immunization, successful session, helping pass signing authority for the APRNs. Some authorization for self-administration for a diabetic child, examine of the provisions that passed on staffing can be incorporated into the competency in a misdemeanor criminal case, certification of mental work being done through the NNA/NONL Safe Staffing Task Force and illnesses, birth certificates, death certificates, life sustaining treatment, ongoing nurse staffing efforts. POLST, do not resuscitate, release for youth sports, handicapped Below is an overview of the important issues for the NNA provided placard, worker’s compensation, and a health certificate for a taxi cab by our lobbyist, as well as a bill tracking report. As you can see, there driver. The Governor signed the bill on June 2nd. It becomes effective were many healthcare related bills introduced this session, and NNA upon passage, except the portions that need to be done through had to pick its battles carefully. regulation. Those portions become effective on January 1, 2018. Also, AB199 allows for PA’s and APRNs to sign POLST forms. This Suicide Prevention bill also sets forth many of the pieces needed in statute to implement AB105, sponsored by Assemblyman Tyrone Thompson, revises POLST forms in practice. The Governor signed the bill May 24th. The requirements for suicide prevention training for certain providers. bill becomes effective July 1, 2017. Under this new law, APRNs must complete at least two hours of evidenced-based suicide prevention training within the first two years Nurse Staffing of licensure. The APRNs must complete follow-up training every 4 SB482 passed and a portion of it involves nurse staffing. Please years. Please reference section 2 of the bill for the portion on APRNs. review sections 1.8, 8.3, and 8.5. A portion of this bill requires From NNA’s perspective, the outcome on this bill was a success. The the State Department of Health to establish a rating system based original language included RNs and was much more burdensome on on their staffing plan compliance. The Board also must establish all professions. The original bill required 3 hours of instruction and a procedure where a facility can request a follow-up inspection or we were able to negotiate that number down. Note: NNA strongly appeal concerning a violation of a staffing plan. This separate state supports the broad goals of this bill – reducing suicide in Nevada. As a rating system must also be publicly posted on the Division’s website result, we are working with the Nevada Office of Suicide Prevention to and at the facility near the entrance in a conspicuous place. Lastly, provide safeTalk Train the Trainers classes for Nevada RNs, in order to this bill makes the selection of nursing representatives on the staffing provide training to nurses and other HCPs throughout the state. committee more specific and allows for alternate members. It also This bill was signed by the Governor on May 26th. That is its requires the signature of all staffing committee members when the effective date, but there is a chance regulations will need to be refusal of a work assignment is done. done, and in that scenario, the effective date for those provisions is July 1, 2017. Note: NNA will have a 2-hour course which fulfills this Nurse Licensure Compact requirement available online soon, which will be free to NNA members As we discussed throughout the session, AB18 was introduced and have a small fee for non-members. to include Nevada in the Nurse Licensure Compact, as an effort to address the shortage needs in the state and streamline the process Medicaid Reimbursement Rates for licensing across state lines. Unfortunately, this bill did not survive. This session, there were four bills that worked to address Medicaid’s The nursing union came out in strong opposition to the bill, and the chronic issue of the underfunding of facilities. Each bill had a slightly bill could not be revived. This bill failed to meet a deadline and died on different focus but legislators primarily wanted to look at the cost of April 14th. health care services compared to the reimbursement rate provided by Medicaid. These policies resulted from the work by the Interim Study Anesthesiologist Assistants on Post-acute care. Post-acute care facilities struggle throughout the SB210 was a bill that would allow for the practice and licensing state due to their reimbursement rates from Medicaid. of AA’s in the state. NNA, in conjunction with the CRNA’s and AB108, was the result of all these discussions. Sponsored by their lobbyist, opposed this bill. As you will recall, the AA’s and Assemblyman James Oscarson, the bill requires Medicaid to review anesthesiologists had a very strong hearing in the Senate policy reimbursement rates every four years. If the rate doesn’t accurately committee but a weaker one in the Assembly. The union also brought reflect the actual cost of care, Medicaid must calculate a rate that their opposition to the bill. The bill missed the May 20th deadline. reflects the actual costs. The Department must then recommend this rate to the Director of the Department for submission under the State Plan for Medicaid. This bill was signed by the Governor on May 19th and becomes effective on July 1, 2017. SimpleWreath APRN Signing Authority There were four bills that addressed the signing authority for APRNs. Of those four, two passed. SB227 allows for APRNs to sign forms that are within their scope of practice. These forms would

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Bill # Sponsor Description Status Position Notes

AB105 Tyrone Revises continuing education Status: Approved Monitor This bill requires 3 hours of continuing Thompson requirements relating to suicide by the Governor. education in suicide prevention for ARPNs. prevention and awareness for certain Chapter 176. providers of health care. (BDR 54-32) Last Action: Mentioned no jurisdiction

AB108 James Provides for the periodic review of Status: Approved Monitor This bill requires Medicaid to review Oscar