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The Offi cial publication of the Virginia nurses Association Volume 16 • No. 2 circulation 88,000 registered nurses and 2,300 student nurses May 2008

The 2008 Virginia General Assembly VNA District 12 Submitted by Kathy Tagnesi, so Just what Happened? President District 12 by Leslie Herdegen Rohr, Government Relations Nursing is licensed as a nurse practitioner. This VNA District 12 community project for a local Representative, Virginia Nurses Association measure passed at the urging of the Virginia Council of Nurse Practitioners, the VNA and the Virginia Board of women’s shelter resulted in over 57 “gift bags” of personal items. ◆ The nursing shortage continued to be the major Nursing. message from the Virginia Nurses Association to Del. Phil Hamilton (R-Newport News) introduced state legislators during the 2008 General Assembly. HB-403 and Sen. Steve Newman (R-Lynchburg) At the same time, we held out little hope for success introduced SB-657, both of which passed the House and given the current budget shortfall. We all know the Senate unanimously and were signed into law by the biggest problem causing insufficient nurses is lack Governor. These measures provides that, in the absence of educational capacity, and that nursing schools in of gross negligence or willful misconduct, healthcare Virginia and across the country turn away nearly as providers who respond to a disaster are immune from many qualified applicants as they are able to accept. civil liability for any injury or wrongful death arising During the preceding legislative session, VNA, from the delivery or withholding of healthcare. with help from many other nursing groups, was able HB-584 introduced by Del. Dave Marsden (R-Burke) to obtain more than $1.7 million to increase public made a technical change to ensure that nurses nursing faculty salaries by ten percent. Unfortunately, practicing in Virginia under the multistate license can this action put private schools of nursing that graduate serve as expert witnesses in medical malpractice cases. more than a third of new nursing grads at a competitive This measure passed. disadvantage in faculty recruitment. Therefore, we Del. Rob Bell (R-Albemarle) introduced HB-1003 at began talking with legislators about the need to the request of his nurse constituents. This measure appropriate some funds for private school faculty requires that data related to the Commonwealth’s increases. The budget shortfall meant that the General nursing workforce, which is currently collected by the Assembly was unlikely to fund any programs perceived Board of Nursing, be published, in aggregate form as “new” and that would require continued funding. and in a format that is accessible to the public, on the Personal items were collected from our district Nonetheless, we were able to continue to get our Department of Health Professions website. This bill members as well as Winchester Medical Center message about the nursing shortage, the major passed. RNs who were working on fulfilling their clinical reason for the nursing shortage, and to educate more After nurses and others raised concerns about his ladder community projects. Two new perspective legislators about what this shortage means for quality HB-399, Del. Hamilton asked that it be stricken from members were identified! and safety of care in the future. So, we continue to the docket in the House Committee on Health, Welfare lay good groundwork for when the economic climate and Institutions. This measure would have allowed changes and more funds are available to tackle this dialysis technicians to have administered erythropoeitic problem’s next steps. agents such as Epoetin alfa, Vitamin D, and iron, which in the dialysis setting are administered IV, Nursing Issues and can be extremely dangerous in this form. Del. Janet Howell (D-Reston) introduced SB-63 (continued on page 3) to ensure that at least one member of the Board of

President’s Message ...... 2 Practice Information The Need to Go Green ...... 11 executive Director’s Communiqué: Nurse Fatigue ...... 11 ...... 4 New Patient Care Innovations in a Holistic Environment: The Planetree Model VCNP featuring an interview with Linda Sharkey, News From VCNP ...... 6 RN, MSN ...... 12 The Jury is in and the Verdict is ...... 13, 14 The youngest and littlest helper was this young The Lead Summit 2008 proudly presents: Legislative-Political Points lady. Perhaps she will be one of our future nurses. Nurse Staffi ng: Public Policy, Private Dr. Audrey Nelson and Cracking the Code of Patient Falls ...... 16 Lets all wish as we look at this award-winning Persuasion, or Both? ...... 5 smile. VNA - Working For you Feature Articles Outstanding Member Award ...... 17 To Blow the Whistle. . . Or Not ...... 6 Welcome New Members ...... 17 When the State Board Calls: Part II Interview with Jay Douglas RN, MSM, CSAC, Executive News At a glance Centra Health and the Health Care Career Presort Standard Director, VA Board of Nursing ...... 7 US Postage See Yourself in 4-D: How to Use Appreciative Center ...... 18 Inquiry to Ignite Positive Change ...... 8 TNCC Receives Grant from Williamsburg PAID Community Health Foundation to Strengthen Permit #14 Health Care Workforce Initiatives ...... 18 Princeton, MN Nursing education 55371 CE Fees ...... 18 Heritage and Future–Green Healthy Work District 2 News ...... 18 Environments ...... 9 2008 Open Offi ces for the Virginia Nurses The Parish Nurse: More Than ‘A Nurse In Association ...... 19 A Church’ ...... 10 Biography and Consent to Serve Form for VNA Elected Offi cials ...... 20 Alternative Approach Membership News A Tale of Two Stones ...... 10 New & Returning Members ...... 21 Membership Application ...... 22 Pa g e 2—Ma y , Ju n e , Ju l y 2008—Vi r g i n i a nu r s e s To d a y www.VirginiaNurses.com president’s message

issue of the VNT for a list of available offices and Acts of Courage duties. Be courageous and consider nominating yourself or a colleague for a Board or District level As I write this column, is the official publication of the Virginia Nurses leadership position. spring is upon us. The buds Association: 7113 Three Chopt Road, Suite 204 In keeping with the quote on courage, this issue of Richmond, Virginia 23226. 1-800-868-6877 and bulbs are blooming the VNT contains pertinent information on the topic www.VirginiaNurses.com, [email protected] and Virginia takes on the of whistleblowing. The Professional Ethical Issues Fax: 804-282-4916 characteristic colors of the section of VNA’s Workplace Advocacy Guide for Bradford Pear, Dogwoods, Red The opinions contained herein are those of the Nurses, also contains additional information specific individual authors and do not necessarily reflect the Buds and Azaleas. It is truly for nurses in Virginia. According to the ANA position views of the Association. a magical time of the year as statement, whistleblowing is the public disclosure we emerge from the doldrums Virginia Nurses Today reserves the right to edit all of unlawful or hazardous activities or practices by of winter. Spring is a busy materials to its style and space requirements and to members of one’s own organization. This often occurs clarify presentations. time for the Virginia Nurses after employees have exhausted all other avenues to Association as we prepare for Te r e s a ha l l e r correct the problem. In whistle-blowing cases, nurses VNA Mission Statement the Week of the Nurse, and for or other healthcare providers may be terminated for The mission of the VNA is to promote education, hosting a meeting (the second advocacy and mentoring for registered nurses to one of three distinct reasons: 1) for speaking out of what we hope will be an advance professional practice and influence the against unsafe practices 2) for violations of federal annual gathering) of nurse specialty organizations delivery of quality care. laws or 3) for filing lawsuits against their employers. on May 14. And with spring follows the graduations Legal experts say the number of whistleblower of nursing students from programs across the bOARD OF DIReCTORS: cases in the healthcare field has been on the rise Terri Haller, President; Shirley Gibson, President- Commonwealth. since 1999, when the Institute of Medicine reported elect; Louise Hileman, Vice President; Ronnette This is also the time of year that the VNA that medical errors are the nation’ leading cause Langhorne, Secretary; Elizabeth Wolkenberg, nominating committee begins working to identify of death and injury. Despite the movement toward Treasurer; Carol Cutler, CODP Chairman; Joe Tuell, qualified members to run for VNA office. In CODP Representative to the board; Esther Condon, “no blame” cultures in the interest of quality thinking about my own tenure on the VNA board, Committee on ethics & Human Rights; Sandra improvement and error prevention, nurses and and my path to two terms as VNA President, I am Olanitori, Commissioner on Nursing Practice; Sallie other healthcare professionals find themselves in reminded of a favorite quote by Anais Nin: “Life Eissler, Commissioner on government Relations; a position to blow the whistle on unsafe practices. shrinks or expands in proportion to one’s courage.” Pam DeGuzman Commissioner on Resources & Whistleblowing by nurses usually results from Policies; Jennifer Matthews, Commissioner on Seeking a leadership position in your professional concern about issues that jeopardize the health or Nursing education; Terri Gaffney, Commissioner association is, in many ways, an act of courage. safety of patients, or place the employee at risk due on WorkForce Issues; Lindsey Jones Cardwell, Rarely do any of us feel qualified or ready to assume to occupational safety and health violations. Director-at-Large; Janice DuBrueler Smith, VNSA a role with responsibilities and time commitments. Representative; Lorna Facteau, President, Virginia To minimize or eliminate the need for Often, leadership positions require that we stretch Nurses Foundation. whistleblowing, healthcare organizations must ourselves, beyond our comfort zone in order to make establish an effective ethical climate that clearly COuNCIL OF DISTRICT PReSIDeNTS: contributions and to make a difference. Sometimes articulates the priorities of the organization, as Linda Larmer, Dist. 1, Far Southwest; Ginger some members will complain about how poorly they Burggraf, Dist. 2, New River/Roanoke Valley; Ellen well as a defined procedure for resolving problems, think things are being done. It takes courage to Morrison, Dist. 3, Central Virginia; Debi Hardway, including ethical disputes or conflicts. choose to be part of a solution or progress, rather Dist. 4, Southside, Hampton Roads; Joanne It takes courage and conviction for professionals than to passively observe or make judgments. Casazza, Dist. 5, Richmond Area; Jan Haas, Dist. 6, to decide to “blow the whistle” in their organizations. Serving on the VNA Board is an excellent Mid-Southern Area; Heidi Malez, Dist. 7, Piedmont Whistleblower laws are in place in many states, Area; Lori McLean, Dist. 8, Northern Virginia; opportunity to expand your horizons in professional to protect workers who chose to speak out, from Joe Tuell, Dist. 9, Mid-Western Area; Ronnette nursing. As a Board member you meet new people retaliation by their employer. However, it is essential Langhorne, Dist. 10, Peninsula Area; Beth Perry, from across the state. You deliberate, discuss and for nurses to understand the specifics of the laws so Dist. 11, eastern Shore; Kathy Tagnesi, Dist. 12, debate issues of importance to nursing and you help Northern Shenandoah. that they fully comprehend the extent and limits of shape the direction of the Association. It can be a legal protection. The risk of employer retaliation is VNA Staff remarkably enriching experience. I invite all VNA a strong deterrent. Retaliation can be in the form of Susan Motley, Executive Director members to seriously consider running for office. being ostracized by co-workers, or being dismissed Kathryn Mahone, Administrative Assistant The Association and the profession needs talent and Tina DeGuzman, Continuing Education from their jobs. Lengthy trials and legal expenses energy to build on the accomplishments of the last Bonnie Gilbert, Membership Coordinator may also occur. several years. There is still much to do. Check out Celine Barefoot, Office Assistant It is an important and courageous act to speak the VNA website (www.virginianurses.com) and this out when patient care and/or patient safety are VNT Staff compromised. The stakes for the employee get higher Susan Motley, Managing Editor if the employer is not responsive to employee, or there Virginia Nurses Today is published quarterly by the are no mechanisms in place to address the issues. Arthur Davis Publishing Agency. Nurses need to understand their rights and the law in Copyright © 2005 their state, when making this important decision. ◆ ISSN #1084-4740 Subscriber rates are available, 800-868-6877 or 804-282-1808. Advertising rates: Contact A. Davis Publishing Agency, 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613. 800-626-4081. Acceptance of advertising does not imply endorsement or approval by the Virginia Nurses Association of the products advertised, the advertisers or the claims made. Rejection of an advertisement does not imply that a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. VNA shall not be held liable for any consequences resulting from purchase or use of advertisers’ products. VNA and publishers reserve the right to reject any advertising. www.VirginiaNurses.com Vi r g i n i a Nu r s e s To d a y —Ma y , Ju n e , Ju l y 2008—Pa g e 3 Sometimes, legislation seeks to restrict access to Safety Issues The 2008 VA General Assembly . . . care. Such was the case with HB-121 introduced by Nurses have a longstanding interest in safety (continued from page 1) Del. Scott Lingamfelter (R-Prince William) that would issues that reduce the incidence of premature have required mental health providers employed by injury and death. As a result, VNA supported HB-27 local governments, Community Service Boards or introduced by Del. Bob Purkey, (R-Virginia Beach). If Two bills were introduced to license freestanding Behavioral Health Authorities to report to the minor’s this measure had passed, it would have prohibited birthing centers. This initiative stemmed from parent that he had sought mental healthcare. Under possession of an open container of alcohol in the 2007 General Assembly action that funded two current law, in most cases a minor can consent to passenger area of a motor vehicle. A violation would birthing centers in Virginia where obstetrical care mental health and substance abuse treatment, have resulted in a civil penalty of a modest $25, is sadly lacking. For these centers to get Medicaid as well as such things as pregnancy testing and but may well have reduced the incidence of drunk reimbursement, they need licensure. Both bills diagnosis and treatment of STDs. This is a crucial driving to some degree. were stricken at the request of the patrons to component of access to care since adolescents may A number of bills were introduced to prohibit the allow another year to work on the concept. They not want their parents to know about their problems. manufacture or sale of cigarettes that do not have a were HB-530 introduced by Del. Brenda Pogge This bill failed to pass when the Senate Committee reduced ignition propensity. It is believed that this (R-Yorktown) and SB-204 introduced by Sen. Fred heard testimony that mental health treatment plans will reduce the number of fires and the injuries Quayle (R-Chesapeake). for minors almost always include family involvement and deaths that result from them because of fires Del. Anne Crockett-Stark (R-Wytheville) early in care, and that almost all minor’s tell their related to careless smoking. These bills were passed introduced two measures to make nursing services parents about the treatment and choose to involve by the General Assembly and signed into law by the more available in schools. Both failed in the House them. Governor. They were HB-228 introduced by Del. John Appropriations Committee, largely for lack of Del Brian Moran (D-Alexandria) introduced Cosgrove (R-Chesapeake); HB-1072 introduced by necessary funding. HB-569 would have required HB-1190 that would have required certain measures Del. Chuck Caputo (D-Fairfax County); and SB-208 each school board to employ at least one experienced designed to lower the infant mortality rate in the introduced by Sen. Walter Stosch (R-Henrico). R.N. to supervise the nursing services provided Commonwealth. These measures would have Nurses’ advocacy on the Indoor Clean Air Act was throughout the school division. HB-570 would have included expanding FAMIS eligibility for pregnant not so successful, in large measure because it was required local school boards to employ one licensed women with an income level up to 200 percent of hotly contested between and among restaurants. nurse for each school building with no more than the federal poverty level; providing coverage for Despite the recent findings on the harm caused by 750 students per nurse. one year postpartum; prohibiting the state from second hand smoke, many legislators chose to leave Del. Vivian Watts (D-Annandale) again introduced charging copayments for prenatal services for state it up to the building owner or operator as to whether her bill to set safe staffing levels for nursing homes. employees; and (v) requiring the Commissioner to allow smoking in the facility or restaurant. This year, HB-1046, if passed, would have required of Health to launch a public education campaign Some of these bills were statewide; others would the Board of Health to establish these standards. aimed at preventing Sudden Infant Death Syndrome. have granted the ability for certain localities to The bill was defeated in the House Appropriations This measure failed in the House Appropriations ban smoking in all or certain public buildings Committee, largely because of funding. The Virginia Committee despite the high infant mortality rate in and/or businesses. Regardless of the wording Nurses Association, however, will be convening a the Commonwealth. or the intent, all of these measures failed in the safe staffing task force to look at options for ensuring HB-1227 introduced by Del. Margie Vanderhye House General Laws or Militia, Police and Public safe staffing for both patients and staff in healthcare (D-McLean) directed the Virginia Department of Safety Committees. The bills introduced and failed organizations. If you are interested in participating Health (VDH) to expand access to breast and cervical were H B-109 introduced by Sen. Mark Coles in this task force, or in providing information to it, cancer screening available under the Every Woman’s (R-Fredericksburg); HB228 introduced by Del Dave please get in touch with the VNA office. Life Program. Since this bill had a fiscal impact, it Englin (D-Alexandria); HB-500 introduced by Del. was referred to the House Appropriations Committee Phil Hamilton (R-Newport News); Del. Harvey Morgan Access to Health Care Issues where it failed to pass. (R-Gloucester); HB-1063 introduced by Del. Bob For many years, nurses have been frustrated Brink (D-Arlington);HB-1253 introduced by Del. Dave by a lack of access to appropriate healthcare Health Care Issues Marsden (R-Burke); HB-1341 introduced by Del. Bill for Virginians who make too much to be eligible Sen. Janet Howell (D-Reston) introduced SB-63 Barlow (D-Smithfield); HB-1432 introduced by Del. for Medicaid but not enough to be able to afford and Del. John O’Bannon (R-Henrico) introduced Algie Howell (D-Norfolk); SB-202 introduced by Sen. healthcare coverage. Thus, they have supported HB-246 to require the State Board of Education Fred Quayle (R-Chesapeake); and SB-347 introduced every opportunity to expand care to these Virginians to develop a database for nutrition and physical by Sen. Harry Blevins (R-Chesapeake). who cannot afford it. activities best practices in schools. Both bills passed Under current law, failure to wear a seat belt is a As a result of the passage of SB-578, the and will become law, although no school division will secondary offense, meaning that an officer cannot VirginiaShare Health Insurance Program will be be required to submit information or follow any of stop a vehicle for this reason, but only may charge created. This program will provide health insurance the best practices. a violator secondary to another offense. Del. Chris premium assistance to allow eligible low-income Del. Bob Marshall (R-Prince William) sought Amundson (D-Mount Vernon) would have made working individuals to purchase health insurance to remove the requirement that girls have an failure to wear a seat belt a primary offense had it coverage through a certified VaShare Health immunization for human papilloma virus before they not failed in the House Militia, Police and Public Insurance Policy. enter sixth grade. We now know that this virus is Safety Committee. For some years, the law has included provisions a primary cause of cervical cancer, so the bill that The remainder of the safety legislation of concern for the re-use of dispensed but unused drugs by created this law in the 2007 session was passed to nurses would have changed the law in ways that hospitals and nursing homes for the use by free clinic with thoughtfulness and concern by the legislators. would have made Virginians less safe. In each case, patients. This law has not resulted in many available Thus, the 2008 General Assembly declined to repeal however, these measures failed to pass. For example, drugs. In an attempt to make it more workable the requirements. Del. John Cosgrove (R-Chesapeake) introduced and productive, Del. Steve Landes (R-Weyers Cave) Del. Marshall also introduced HB-188 that sought HB-225 that would have exempted children older introduced HB-85. This measure passed. to delay this requirement from 2008 to 2010. The than 6 being transported in minibuses and certain A companion bill introduced by Del. General Assembly also failed to agree to this change. Landes, HB-86, would have created an unused (continued on page 4) pharmaceutical disposal program. This measure would have provided for the safe, effective and proper use of unused pharmaceuticals. This bill was carried over to the 2009 session for further consideration and possible modification. Pa g e 4—Ma y , Ju n e , Ju l y 2008—Vi r g i n i a Nu r s e s To d a y www.VirginiaNurses.com ExecutiVE DirectOR’s Communiqué The 2008 VA General Assembly . . . (continued from page 3)

It’s spring! What a perfect supply and demand with Virginia specific data. The time to regroup, get organized, project is expected to begin the first of July. vans from the requirement to wear child restraint and put your calendar As you all know, one of the critical components devices as long as they wore seat belts. This bill failed together for the rest of 2008. of the nursing shortage is the lack of education in the House Transportation Committee. There are exciting things capacity that causes qualified students to get turned Three bills that could have put motorcyclists at going on with nursing and in away from nursing schools in Virginia each year. We greater risk of injury or death also failed, in part this issue, VNA’s government are pleased to announce that under the leadership because of the urging of nurses. HB-48 introduced relations specialist, Leslie of Marilyn B. Tavenner, Secretary of Health and by Del. Mark Cole (R-Fredericksburg) would have Herdegen Rohr, has given you Human Resources, Virginia applied for a competitive allowed motorcycles to travel two abreast. Del. Scott an in depth recap of the 2008 slot for a national education summit. Virginia was Lingamfelter (R-Prince William) introduced HB-1173 General Assembly Session. As one of fourteen states to be accepted to this summit that would have allowed certain motorcycle drivers you can see, there is no time that will take a look at best practices for expanding and riders over the age of 21 to ride without helmets. to rest! We are already looking Su s a n Mo t l e y educational capacity by sharing best practices, Finally, Del. Chap Petersen’s (D-Fairfax County) ahead to next year, so please innovation, and developing a strategy for Virginia. SB-698 that would have reduced the penalty for make sure you are getting the Please help the association continue to support failure to wear a motorcycle helmet from a traffic public policy emails and your VNA member emails. this great work being done on behalf of nursing in infraction with a $250 fine to a civil violation with a Visit www.virginianurses.com to make sure you are Virginia by joining the association today. Visit www. penalty of $25 also failed. up on the latest issues. virginianurses.com for membership information and HB-1337 would have made it unlawful for a child Exciting news! As you know from the Richmond an application. For the cost of a little over twenty younger than six years of age to be left unattended Times Dispatch supplement for the week of the dollars a month, you can help move nursing forward in a motor vehicle if the conditions within the vehicle Nurse, or if you attended the Nursing Roundtable and assure that the future health care needs of or in the immediate vicinity of the vehicle, including at VCU School of Nursing, Virginia is getting Virginia’s citizens are met. There has never been a outside temperature, presented a risk to the health or a Healthcare Workforce Data Center. Sandra better time to be a member of VNA! safety of the child. This bill, introduced by Del. Bill Whitley Ryals, Director, Virginia Department Save the date! Plan to join us at the Richmond Barlow (D-Smithfield) failed in the House Courts of of Health Professionals, announced that the Marriott on Saturday, October 25 for VNA’s education Justice Committee. Governor’s Discretionary Fund under the Workforce day: The Staffing Imperative. Gain nursing continuing Reinvestment Act awarded $275,000 to establish the education, networking, and practical knowledge Study Resolutions program. The center, which will be housed within for dealing with the number one nursing issue in Many resolutions related to healthcare were the Department of Health, will be able to collect Virginia. Plan to stay the evening for the Virginia introduced, but almost none of them passed. One and analyze data in order to recommend strategies Nurses Foundation Gala celebrating excellence in that did was HJR-79 introduced by Del Phil Hamilton for dealing with the growing gap between nursing nursing. Details to follow in our next issue and on (R0Newport News) that requests the Governor and the the website at www.virginianurses.com. Secretary of Health and Human Resources to develop a policy barring physicians or other healthcare practitioners from prescribing an alternative brand of medication because of financial incentives without first disclosing the incentives to the patient. A study that was of particular interest to nurses was introduced by Del. Kris Amundson (D-Mount Vernon) as HJR-207 and by Sen. Edd Houck (D-Spotsylvania) as SJR-128 at the request of the AARP and with the support of the VNA. Both measures failed in the House Rules Committee. These resolutions would have asked the Joint Commission on Health Care to determine whether the licensure boards for health professionals should require evidence of continued competence at the time of relicensure, and if so, what those requirements should look like. VNA supports requirements to demonstrate continued competence, but believes this demonstration should include options other than just continuing education requirements. Conversations between nurses and the AARP will continue over the interim before the next session.

For More Information More information on any of these bills, or any other bill related to nursing, healthcare, or safety, can be accessed on the Virginia Nurses Association’s government relations page found at www. virginianurses.com. ◆ www.VirginiaNurses.com Vi r g i n i a Nu r s e s To d a y —Ma y , Ju n e , Ju l y 2008—Pa g e 5 legislative–political points

Nurse Staffing: Public Policy, Private Persuasion, regulations set nurse staffing levels that identify the nursing requirements of individual patients by unit or Both? and by shift. They then allow for adjustment based by Leslie Herdegen Rohr, VNA Government Relations reimbursement for nursing home and many on patient acuity. Representative other services. Daily reimbursement for Some examples of nurse-to-patient ratio Medicaid residents in nursing homes is less requirements for specific units in California hospitals The purpose of this article is not to review in a than $100, far too little for the quality of are: medical/surgical 1:6; pediatrics 1:4; emergency scholarly fashion the benefits and drawbacks of care we all would like to see. This is not a room 1:4; step down from critical care 1:3; telemetry staffing laws, regulations and private standards. problem in nursing homes that have only 1:4; specialty care (e.g. cancer) 1:4; operating room Rather, it is to provide an introduction to nurse staffing a few residents who rely on Medicaid; it is a 1:1; antepartum 1:4. to begin a broader discussion among nurses in Virginia truly great problem for nursing homes with Florida passed legislation requiring minimum on whether there is a need to provide more effective a high percentage of Medicaid patients. staffing requirements for nursing homes in 2006. methods of ensuring adequate and safe nurse staffing. VNA has supported increasing Medicaid The requirements call for 2.7 hours of direct care per VNA needs your comments as we move forward. reimbursements for nursing home residents to resident per day. They also require at least one CAN Nurses care deeply and passionately about begin to overcome this problem. per 20 residents and a minimum of one licensed patient safety, quality patient care and good patient 2. The nursing shortage. We have solid data nurse for one hour of direct care per resident per outcomes. But all too often we hear from you that on the shortage of RNs in Virginia and the day. They also prohibit having less than one nurse you are prevented from providing the best possible projected worsening of this shortage. While for 40 residents under any circumstances. This law safety and care, and see poorer outcomes, because we do not have data on shortages of LPNs is similar to legislation introduced in Virginia by Del. you work under less than optimal circumstances. and perhaps even CNAs, we are fairly certain Watts in past years. Most often, inadequate nurse staffing and too the same or similar conditions exist in these many patients per nurse are the concerns you professions. It is illogical to mandate staffing Public Reporting of Nurse Staffing express. You tell us you have too many patients levels if professionals are not available to fill Vermont has changed its Bill of Rights for Hospital to spend enough time with each to do proper the required positions. This could result in bed Patients to require public access to nurse staffing nursing assessments and monitoring. Too many closings and unavailability of nursing home ratio information. responsibilities are performed by unlicensed services. VNA, along with legislators, saw New Jersey requires hospitals and nursing homes personnel or CNAs, despite Virginia’s delegation this as causing greater harm than inadequate to record and post daily staffing information for each law that specifies very clearly what tasks may be staffing. VNA has worked to ensure that there shift on each unit. This information also is reported delegated to unlicensed individuals. Most recently, are more RNs available in Virginia, and is to the Commissioner of Health and Senior Services we heard from a nurse in a rural hospital who told considering whether it can determine the LPN monthly, and made available to the public on a us it is not unusual for her to have ten or eleven and CNA supply and demand to determine quarterly basis. patients for whom she is responsible. She noted whether action is needed in these areas, too. dissatisfaction with the care she is able to provide, 3. Ceilings, not floors. The concern that is solely Actions in Other States along with general career dissatisfaction. VNA’s is that staffing requirements often Maine, which had established nurse-to-patient Virginia is not the only state to hear concerns like become ceilings rather than floors. While ratios, has removed those required ratios. Instead, this; the problem is pervasive. There are a number of staffing requirements are meant to set a they now defer to the Maine Quality Forum Advisory ways that state nursing associations have addressed minimum level of staff, or staff contact hours Council. The Council has indicated that they see these concerns. Perhaps the time has come for with patients or residents, they can also no reliable scientific evidence that nurse-to-patient Virginia to look at the best way to address these provide incentives for facilities with higher ratios guarantee quality and safety of patient care. concerns in the Commonwealth. staffing levels to staff down to the minimum Instead, the Forum has recommended the collection to save money. This would be particularly of 15 nurse-sensitive indicators in hospital settings. The Current Situation in Virginia possible in nursing homes with many private The District of Columbia waived enactment of Hospitals in Virginia are licensed by the pay patients that, today, have excellent staffing staffing standards enacted earlier in the decade due Department of Health under a set of regulations ratios and contact hours with residents. So, to the nursing shortage. that are considered and approved by the Board of the risk of staffing requirements is that they Finally, some states have enacted staffing ratios Health. Current hospital licensure regulations track would decrease levels of staff and quality of in certain units in hospitals, most often in the Medicare Conditions of Participation. They require care in some licensed healthcare facilities. operating room. that the “number and types of nursing personnel on At the same time, VNA continues to receive all shifts shall be based on the needs of the patients communications from nurses working in licensed Most Recent State Actions and the capabilities of the nursing staff assigned to healthcare facilities with RN-to-patient ratios that During 2007 state legislative sessions, eight states the patient care unit.” We are unaware, however, that far exceed what the research shows to be necessary introduced staffing plan bills; eight states introduced any hospital has been cited for inadequate nurse to prevent adverse events, morbidity and mortality staffing ratio bills; and two states introduced staffing staffing. of patients. And, we know that nurses working reporting legislation. While Illinois passed a measure Similarly, skilled care facilities track this under these suboptimal conditions face higher levels that strengthened a public reporting law to require language: of job dissatisfaction, which is likely to result in safe staffing levels, it appears that none of the other The nursing facility shall provide qualified nurses nurses leaving direct care, or leaving the profession states’ measures passed. Combined with the fact and certified nurse aides on all shifts, seven days altogether, worsening the nursing shortage. that so few states have staffing laws of any kind, it per week, in sufficient number to meet the assessed Maybe the time has come for VNA to revisit its becomes obvious that the arguments of opponents nursing care needs of all residents. Nursing personnel, position on staffing standards. As a first step in to staffing laws, healthcare employers (i.e. hospitals, including registered nurses, licensed practical that consideration, we reviewed the ways nine other nursing homes, ambulatory surgery centers) have nurses, and certified nurse aides shall be assigned states and the District of Columbia have addressed traction. This means that nurses must be prepared duties consistent with their education, training and these concerns. for a major educational and lobbying effort to experience. overcome the opposition. Regulations for other healthcare facilities licensed Staffing Plans in Virginia are similarly vague. Between 2002 and 2007, Texas, Rhode Island, The Future in Virginia The Joint Commission on the Accreditation of Oregon and Illinois have enacted legislation or Perhaps the time has come for the Virginia Nurses Health Care Facilities recognizes that adverse patient adopted regulations that require hospitals or all Association to explore the current staffing situations outcomes are directly related to inadequate and licensed healthcare facilities to develop, implement in Virginia, note any that appear to compromise ineffective nurse staffing levels. It describes effective and enforce a staffing plan that includes such things patient care, and decide how to rectify those staffing as: “providing optimal numbers of competent as the number and types of nurses on each unit on situations. To make that determination, however, personnel with the appropriate skill mix to meet the each shift and the average number of patients on we need to hear from nurses working on the ground needs of an organization’s patients based on their which staffing levels are based. The staffing plans about what their staffing concerns are, and from mission, values and vision.” are to be developed with some input from direct those who work in facilities that are doing it right. Del. Vivian Watts (D-Annandale), a long-time care staff nurses, either in an advisory or decision- We have nine magnet hospitals in Virginia. A proponent of senior citizens and quality healthcare, making capacity. magnet hospital is one where nursing delivers has worked for years to establish staffing standards In most cases, these staffing plans must be excellent patient outcomes, where nurses have a in nursing homes or asking the Board of Health consistent with national research, standards adopted high level of job satisfaction, and where there is a low to establish staffing standards by regulation. She by the state licensing board, specialty standards, and staff nurse turnover rate and appropriate grievance has an advocacy group of residents’ families and guidelines, and patient acuity. States may or may not resolution. Magnet status also indicates nursing nursing home staff backing her efforts. Nonetheless, have required the facilities to submit the plans to the involvement in data collection and decision-making her bills have failed to pass for many years. And licensure agency, or to make them public. In the case in patient care delivery. So we know those hospitals 2008 may be no different; Del. Watts’ HB-1046 of Oregon, civil penalties for failure to comply with place a high value on nurses and the difference they was reported from the House Health Welfare and the plan have been attached. make in safe and quality care. Institutions Committee, but re-referred to the House We also know your colleagues, the nurse Appropriations Committee, indicating that the Staffing Ratios executives, share your concerns about nurse staffing, General Assembly may find a fiscal impact and, as a Three states have adopted laws that require and we should hear from and work with them as we result, kill the bill in this budget shortfall year. specific nurse-to-patient ratios. decide whether and how to move forward. While VNA has been sympathetic to the residents California adopted legislation in 1999 to require Together, we can help ensure the best patient care and staff in some nursing homes that have truly that regulations to define specific nurse-to-patient in Virginia. ◆ inadequate staffing and care levels, until now, we ratios in all nursing units in all hospitals. This is have shared the two major concerns of legislators the most far-reaching staffing law in the country. and have one other concern. Those concerns are: Delayed by a gubernatorial suspension of the law 1. The level of Medicaid reimbursement. Virginia that was fought through the courts for several years, has one the of the lowest levels of Medicaid nurses prevailed and the ratios now are in effect. The Pa g e 6—Ma y , Ju n e , Ju l y 2008—Vi r g i n i a Nu r s e s To d a y www.VirginiaNurses.com News From VCNP To Blow the Whistle…or Not by Leslie Herdegen Rohr, VNA Government Relations volunteers, patients, residents, families, and others by Diane Walker, RN, MSN, FNP Representative who have an interest in the rights of patients or President, Virginia Council of Nurse Practitioners residents of hospitals, nursing facilities, or assisted Cynthia Cooper. Colleen Rowley. Sherron Watkins. living facilities. The Virginia Council of Nurse Practitioners Only the most serious news junkies will remember While this sounds clear and easy, in practice, it hosted our 34th Annual Conference in Roanoke, these accomplished but otherwise ordinary women often is not. First, there are no standards embodied Virginia on March 5-8. We came together- 375 nurse who graced the cover of Time Magazine when 2002 in these laws. Therefore, what one person may see practitioners strong- for educational opportunities, was declared “The Year of the Whistleblower.” These as a violation of patient rights may not be seen by networking with our peers, appreciating our history. women made hard choices when they went public others in a similar fashion. Furthermore, there is It was a beautiful venue at the Hotel Roanoke. with wrongdoing at Worldcom, the FBI, and Enron no specified remedy for a healthcare organization Thanks to Cindy Fagan, conference chair, the respectively. Their actions were the right thing to do, that retaliates under these circumstances, so any conference committee, and to our local hosts in resulted in justice, and changed their lives forever. remedy by an employee will be in civil court, often a Roanoke for facilitating an outstanding conference. From elementary school on, we are taught by our protracted and costly proceeding. We hope to see you next year at the Williamsburg peers that tattling is one of the worst sins that can be Thus, it may be helpful to look at what others say Lodge, March 18-21. committed. Yet, during this century, whistleblowing about the protection of patient rights before relying One of the conference highlights was listening to has become an admired quality. What has made on these laws exclusively. Corinne Dorsey, former Board of Nursing Executive the difference? Perhaps there is a sense that Director, who gave a fascinating talk on our history. organizations, particularly big businesses, have so What JCAHO Says I came away being reminded of how much of a much power that they are able to take advantage of While the Joint Commission on the Accreditation difference an individual can make pursuing with ordinary Americans and literally ruin their lives. No of Health Care Organizations does not specifically passion and integrity, that which you believe in. I am longer do employees work for the same corporation require due process and other protections for staff grateful to those who have preceded us, for clearing their entire lives–the corporations do not seem to members who intervene on behalf of patients, they so many hurdles. have the same loyalty to their employees, and the are required to have “structures to support patient When I look at our current practice environment, employees do not seem to have the same loyalties to rights… in a collaborative manner that involves the hurdles we face today are those that prevent us their employers. Of course, there are exceptions to the hospital’s leaders and others.” JCAHO also from practicing to the full extent of our training and this, but they are the exception rather than the rule. requires healthcare organizations to have mission capability. The healthcare challenges that we face Or, perhaps it is that as young children, we are statements and a patient bill of rights that reflect are many. Nurse practitioners are so well poised to unable to recognize that our primary loyalties the organization’s basic beliefs. So, while JCAHO be leaders in solving many of those challenges. We, can and should be overridden by compelling moral does not require structures to encourage internal as nurse practitioners, serve as an effective bridge in reasons. This is a distinction that, even as adults, we reporting or prohibit retaliation against an employee the integration of nursing and medicine. have trouble making. who goes public with an unresolved concern, in Speaking of leaders, this is the time of year some cases, these may be extrapolated from JCAHO- that some of our eleven regions transition to a new What is Whistleblowing? required statements. President. To assist in that transition, the Board of While some define whistleblowing broadly, You will want to note that many assisted living Directors at VCNP will sponsor a Board Development most make a distinction between “reporting” and facilities are not subject to JCAHO requirements. and Strategic Planning Session. This year, we will “whistleblowing.” Reporting recognizes that most meet in Charlottesville beginning Friday evening, healthcare organizations have an internal process for What the ANA Code for Nurses Says May 30 and continuing all day on Saturday. We sharing employee concerns in an environment that While the Code for Nurses also does not encourage all elected officers of the regions, as well allows them to be addressed within the organization. specifically state what values should be upheld and as committee chairs to join us. Whistleblowing, on the other hand, is construed as what responsibility RNs have for reporting internally It is my great honor and privilege to serve an external action to an organization that has not or externally specific situations, Provision 6 of the as President of the Virginia Council of Nurse responded appropriately to a concern expressed by ANA Code for Nurses reads: Practitioners. As is true with many volunteer an interested party. Many whistleblower laws require The nurse participates in establishing, opportunities, the service provided is rewarding that internal reporting mechanisms be utilized first. maintaining, and improving healthcare and the rewards in return are many. Join us! Please Even if the law does not, this is a good and ethical environments and conditions of employment consider a more active role in your professional standard to follow. conducive to the provision of quality organization by volunteering to serve in your local healthcare and consistent with the values chapter. ◆ Whistleblower Laws of the profession through individual and Whistleblower laws have been passed at the state collective action. and federal level to allow employees to stop, report This and other provisions of the Code when read Save the Date or testify about employer actions which are illegal, as a whole, should give nurses some guidance as to VNA’s 2008 Delegate Assembly will be unhealthy, or violate specific public policies by their role as a healthcare professional in reporting held on Friday, October 24th. prohibiting retaliation against that employee. and helping to correct unsafe, inappropriate, or There are more than fifty federal whistleblower negligent practices. You can read the entire Code New this year, a Saturday Education laws. Some of them relate directly to healthcare at http://nursingworld.org/ethics/code/protected_ Day, The Staffing Imperative—please organizations. Others are more broad and include nwcoe813.htm. plan to attend and stay for the evening’s Gala employees in many industries. Many are administered Celebration of Nursing Excellence to by the Federal Department of Labor; others are Other Considerations benefit the Virginia Nurses Foundation. administered by other federal agencies. Some have Since external whistleblowing (as well as internal For details, visit statutes of limitations of as little as ten days; others reporting) can have serious consequences for the www.virginianurses.com are much longer. Some have administrative remedies; nurse and the organization, it is not an action that some allow for civil remedies; and still others provide you will want to take lightly. At the same time, failure no remedy at all to an employee who alleges retaliation to report or blow the whistle can be life-threatening as a result of his whistleblowing activity. for patients as well as staff. Here are some additional Entire books have been written and published on considerations you will want to weigh as you decide federal whistleblower statutory laws and case law. It how to proceed: is not within the scope of this article to review these • Do your concerns represent a substantial risk laws. Instead, it will focus on Virginia laws that to patient or staff safety, healthcare outcomes, prohibit retaliation against whistleblowers in certain or morbidity or mortality? healthcare settings and some things you might want • Are your concerns the result of a single event, to consider before you make a decision to blow the or a pattern of practice? whistle.. • Have you fully investigated the situation, collected appropriate facts and other data, Virginia’s Health Care Whistleblower Protections and thoroughly understand the situation as Virginia has three laws that protect complainants well as potential reasons behind it? against retaliation or discrimination in hospitals • Have you exhausted established internal (Va. Code § 32.1-125.4), nursing facilities (Va. Code processes before you think about making your § 32.1-138.4) and assisted living facilities (Va. Code concerns public? § 63.2-1730). By utilizing the term “complainant,” • Do you have a positive tenure and reputation these laws apply not only to employees, but also to within your organization or profession? • Have you thought about the need for a legal consultation or legal representation?

Note of Caution Reporting inadequate conditions in healthcare organizations, and ultimately deciding to blow the whistle on those that are not corrected, is a complex area of state and federal law. Making a decision in this area also requires scrutiny of the ANA Code for Nurses and JCAHO require. And neither this article nor your personal judgment should be a substitute for good legal counsel or representation with experience in this area. So let your conscience be your guide as to whether you need to investigate your options more fully. ◆ www.VirginiaNurses.com Vi r g i n i a Nu r s e s To d a y —Ma y , Ju n e , Ju l y 2008—Pa g e 7 Pa g e 8—Ma y , Ju n e , Ju l y 2008—Vi r g i n i a Nu r s e s To d a y www.VirginiaNurses.com how does the organization See Yourself In 4-D: How to Use Appreciative Inquiry look? How is your work or day different? To Ignite Positive Change What are some of the ways that you’re interacting with by Susanne E. Gaddis, PhD and Cara Williams To uncover the current situation, you will begin others in the organization that by asking carefully constructed positive-focused are working for you? Is your organization questions. Here, among other things, your goal is to During the Dream step, the currently in the midst discover what drives success, contributes to employee possibilities are endless. Give of making changes? Are satisfaction, and helps maximize productivity. The yourself and members of your you looking for ideas to purpose of the questions asked during this stage organization the gift of no improve your processes in the process is to discover how the organization is boundaries in order to dream while increasing employee a r a i l l i a m s most alive and successful. The goal here is to create your biggest dreams. C W satisfaction and retention? an open-dialogue where information flows freely. Design: Once you’ve If you are ready to discover Here is a sample of questions designed to help you discovered strengths and possibilities in the last new ways to maximize your illicit positive responses during the discovery stage: two stages, you’ll want to find ways to achieve these organization’s productivity and Share a time with me where you felt the happiest/ dreams. So now that you’ve discovered “what might efficiency, then all you need to most successful at your job? be,” your job in the Design phase is to discover do is ask the right questions. Su s a n n e Ga d d i s What first attracted you to this job? “how can it be.” Here, you’ll generate “possibility Appreciative Inquiry allows Tell me about a time when someone has recently statements,” also termed “provocative propositions.” you to do just that. helped you succeed at a task? Possibility statements are designed to stretch the So what is Appreciative Inquiry? It’s a verbal What makes your work meaningful? status quo, be grounded in the organization’s history, science that’s been around since the 1980’s, that What do you find most exciting about your and, most importantly these statements focus on the shows us how to ask questions in a way that will position? desired future. The result of this stage is that you elicit positive responses. By using this model you If I asked your friends to share with me three of will have a series of paragraphs that outline how the can gain a fresh new perspective and spur positive your best qualities, what would they say? Dream will be realized. The big question to ask at change within your organization. The reality is that Where do you gain your inspiration? this state is “how can we go about achieving what we wonderful things can begin to happen when you stop If you were the manager of the organization, in envisioned in the Dream phase?” focusing on the negative and start focusing on the what area would you focus more of your time? Destiny: Now, that you have generated a list of positive. What is most pleasing to you? possibility statements, its time to make your dreams Why is this new method of gathering information What do you feel confident about? a reality. This step focuses on “what will be.” At this effective? Because, it’s different than how we’ve Tell me about a time where you felt reassured? point in the process, you will choose what you will done things in the past. Because most people think What three things have you liked most about your move forward with. You will begin to incorporate thoughts that are 70-90 percent negative or of no use time here thus far? the possibility statements with your job, your team, to them, it’s very easy to understand why we tend What do you value most about the nature of your and your organization. Here you’ll find ways to apply to ask questions that focus on what’s wrong, rather work? overall Appreciative Inquiry process to your overall than asking questions that focus on what’s right. Tell me about a time where you felt your culture. Destiny is not an end to the process, but the We ask “who made the mistake,” rather than organization was most connected to its patients? beginning to a whole new way of doing business. asking, “What options do we have to fix things?” We What do you think draws people to work here? Appreciative Inquiry just makes sense when you ask “who can be blamed for this,” rather than asking If you could talk to the President of the stop to think about it. People tend to gravitate in “what did we learn from this?” Or, we ask, “what’s organization, what is the one thing he/she could do the direction in which they are focused on the most. wrong with this picture,” rather than asking, “What to make your job better, faster, or more enjoyable? Therefore when you focus on the negative, your am I doing right?” In short, in the past we had a Dream: After identifying the current situation or problems will just get bigger and more overwhelming. “what was I thinking,” or “what were they thinking,” “what is,” the next step in the Appreciative Inquiry However, by giving yourself and your organization mentality. process allows you to focus on “what might be.” Here the gift of Appreciative Inquiry, you will focus on the So who invented Appreciative Inquiry? Two are some positive-focused questions that will help positive and begin to be awed by the differences it professors, David Cooperrider and Suresh Srivastva, you to navigate this stage: can make. Remember, small changes to questions at the Weatherhead School of Management at Case Imagine and tell me what your perfect shift would you may already be asking or small changes to your Western Reserve University. To date, hundreds look like? current outlook will help you ignite positive change. of people have been involved in co-creating new What are your deepest desires for the Dr. Susanne Gaddis, PhD, known as The concepts and practices for applying the spirit organization? Communications Doctor, is an international and methodology of Appreciative Inquiry into If you could wave a magic wand and have exactly professional speaker, communications consultant, organizations all over the world. what you desire, what would that be? and executive coach. Workshop leader, Cara The Appreciative Inquiry Process consists of a 4-D If a genie granted you three wishes pertaining to Williams, M.A., offers courses in appreciative cycle: Discover, Dream, Design and Destiny. your job or organization, what would you ask for? inquiry, positive organizational development By using these four steps, you too can begin to If you could fast-forward three to five years into and emotional intelligence. To Contact Cara or use this positive process to grow your organization. the future and imagine that your highest hopes and Susanne, call 919-933-3237 or e-mail: gaddis@ Discover: The first step in the Appreciative dreams for your organization have become a reality, communicationsdoctor.com ◆ Inquiry cycle focuses on identifying “what is.” www.VirginiaNurses.com Vi r g i n i a Nu r s e s To d a y —Ma y , Ju n e , Ju l y 2008—Pa g e 9 Nursing education

Hospitals for a Health Environment at www.h2e-online.org Heritage and Future–Green Healthy Work Environments Hospitals for a Healthy Environment (H2E) is creating a Jennifer Matthews, PhD, CNS-BC own exposures. (http://www.ewg.org/sites/ national movement for environmental sustainability in healthcare. H2E was jointly founded by the American Commissioner on Nursing Education nurse_survey/analysis/summary.php; Hospital Association, the U.S. Environmental accessed from the Environmental Working Protection Agency, Health Care Without Harm, and It is Spring… and finally it is time to be GREEN. As Group on March 21-2008) the American Nurses Association. H2E is educating one comes out of Winter, it seems so long since there This is a clarion call to all nurses to be actively healthcare professionals about pollution prevention was green. involved in the decisions that affect their workplace opportunities and providing a wealth of practical tools and resources to facilitate the industry’s movement environment and work conditions. Each nurse toward environmental sustainability. A commitment for each should ask questions, find out the composition of Health Care Without Harm at www.noharm.org nurse is to make life GREEN the products we touch daily, are these absorbed This is a global coalition of over 460 organizations in year ‘round. You can create into the body, how are these disposed of, what is the more than 50 countries working to protect health by green year ‘round by making carbon-foot print (how much energy and pollution reducing pollution in the healthcare sector Virginia Nurses Association at www.virginianurses.com a pledge backward to Florence are involved in the production, delivery, and disposal American Nurses Association at www.nursingworld.org Nightingale and forward to of the product). Examine the work environment ANA CE module: http://nursingworld.org/mods/ all the future Nightingales and the design not only for toxic elements, but also mod921/cesafull.htm to provide our patients for elements that stress the care provider such as Children’s health: Safe workplaces and healthy (and ourselves) with the length of the halls, lighting, and the amount of extra learning places: Environmentally health schools. The Center for American Nurses at healthiest environments walking to retrieve supplies. Be proactive in selecting www.centerforamericannurses.org with a focus on conservation. equipment and designs to eliminate musculoskeletal EnviRN.umaryland.edu: a one-stop shop created by the There is momentum today injuries through use of lift devices, include overhead University of Maryland School of Nursing for nurses advocating for Healthy Work Je n n i f e r Ma tt h e w s lifts in renovation and newly designed spaces. interested in environmental health. Environments (HWE) and to Nurse Educators in the practice settings and Curriculum by Barbara Sattler for schools of nursing from a Kellogg grant: open to the public to use; http:// be environmentally conscious–to reduce the carbon nurse educators in the academic settings should envirn.umaryland.edu/kellogg/index.html and http:// foot-print in one’s life both at home and at work. include learning activities to educate nurses about envirn.umaryland.edu/Curricula_Education/ There are similarities and parallels with these two their work environment, the products and their http://www.deq.state.va.us/p2/vh2e/ causes; nurses can promote both simultaneously. chemical burden, and how to eliminate dangers VH2E is Virginia’s voluntary partnership to minimize This awareness of the environments of our lives is of injury. There are online learning continuing the environmental impacts of the healthcare industry. VH2E was developed in support of the national rooted in history and projects far into the future. education courses and academic courses that focus Hospitals for a Healthy Environment program. Nightingale promoted health through the careful on safety, healthy environments, safe handling [Virginia department of environmental quality] control of the patient’s environment despite bad and movement environments, and chemical The Environmental Working Group at www.ewg.org sanitation, bad architectural [design and elements], exposure in the healthcare settings. Barbara Skin Deep at www.cosmeticdatabase.com and bad administrative arrangements (p. 8, 1860). Sattler, Ph.D, RN, FAAN, through a Kellogg grant, Skin Deep is a safety guide to cosmetics and personal care products brought to you by researchers at the For the environment, Nightingale demanded there created teaching modules, based on the IOM Environmental Working Group. Skin Deep pairs be excellent ventilation (pure air and air flow), pure recommendations, that can be integrated into any ingredients in more than 25,000 products against 50 water, efficient drainage (sanitation, i.e., proper school of nursing curriculum that will introduce definitive toxicity and regulatory databases, making handling of body substances), cleanliness, natural students to environmental issues at the personal it the largest integrated data resource of its kind. light and exposure to sunlight, and noise control. and professional levels as well as with in the local Why did a small nonprofit take on such a big project? Because the FDA doesn’t require companies to She spoke to two settings of care, the home and the and global community. test their own products for safety. This allows the hospital. And nurses should do the same today for Nurses and nurse educators can access up-to- consumer to determine whether the personal care their living environment at home and in the practice date materials and apply this information to their product used daily, is part of a toxic chemical load setting. workplaces. There are advocacy groups who can being absorbed into the body. Nurses live in their workspaces–or so it seems assist–a number of hospitals and practice settings in Patient Safety Center of Inquiry and Patient care ergonomics resource guide from the Tampa VA system by the end of a workshift caring for patients. Their Virginia are part of the Virginia H2E activities and at www.patientsafetycenter.com work environments matter for the staff and for the with the assistance of the environmental experts The Center for Health Design at www.healthdesign.org patients. We are gaining awareness of the chemicals on staff can provide valuable information that can Green Guide for Health Care at www.gghc.org in the environment, we are gaining knowledge of lead nurses to lead change. The American Nurses Planetree at www.planetree.org the effects of these chemicals. Many chemicals are Association, The Virginia Nurses Association, and The Nightingale Institute for Health and the Environment at www.nihe.org (the web site remains but as of 2006, not inert, for once these have entered the body, The Center for American Nurses have information the institute no longer exists) the chemicals reside long-term adding to a toxic on healthy work environments on their websites. At Sustainable Hospitals Project www.sustainablehospitals. body-burden that increases genetic mutations and the end of this article, there is a list of websites and org promotes cancer development. contacts that can assist the nurse in self-education Whole Building Design Guide at www.wbdg.org In 1995, the Institute of Medicine (IOM) published about this timely movement for environmental information that hospital environments needed causes. Encourage your colleagues and to change dramatically to be healthier. By 1998, administrators to take advantage of the available the American Nurses Association (ANA), together knowledge and assistance. Begin with a small project with the American Hospital Association, and within your facility–recycle batteries for example, and the Environmental Protection Agency formed then begin to include more projects that will create a a partnership named Hospitals for a Health healthier work environment or save the environment. Environment (H2E). The goals have been to We need to act with vision and commitment to eliminate the use of mercury in healthcare and create a healthy environment for ourselves, our to eliminate the use of hazardous and persistent, families, and our future. We need to return to our bio-accumulative and toxic chemicals. H2E has Nightingale heritage to help us renew the values and worked to do so and more and more nurses and sustain the vision. ◆ other healthcare personnel are involved in the discovery of toxic chemicals in their environments References and sources and finding environmentally friendly alternatives Nightingale, F. (1860). Notes on nursing: What it is, and what it not. [1969 re-publication]. New York: Dover Pub. through selective purchasing from medical device/ supply manufacturers. Virginia is a partner in this H2E project; this is administered through the Commonwealth’s Department of Environmental Quality. Most nurses can cite the move from latex gloves to the use of nitrile products for latex-free environments and as well as the removal of mercury from the hospitals. These are but two initiatives needed, by now, we should to be able to readily cite other health-friendly and eco-friendly transitions. Following a 2007 survey that ANA jointly sponsored, five recommendations were made; two of these are: 1. Healthcare facilities should act now to replace hazardous materials and to provide engineering controls nurses need to reduce exposures. Hospitals should phase out mercury-containing equipment, replace or control hazardous sterilizing agents, construct ventilation systems to clear waste gases from the air, and phase out latex gloves. They should monitor the air, surfaces, and even nurses’ bodies for chemicals. They should educate nurses on the hazards and safe use of chemicals and other hazardous agents. And they should not wait for these actions to be mandatory. (emphasis added) 2. Nurses should work within their own facilities to catalyze these changes and reduce their Pa g e 10—Ma y , Ju n e , Ju l y 2008—Vi r g i n i a Nu r s e s To d a y www.VirginiaNurses.com Nursing Education Alternative Approach The Parish Nurse: More Than ‘A Nurse In A Church’ A Tale of Two Stones Reen Markland, RN, FCN Parish Nurse Resource Center (IPNRC) by 35 parish by Brian Lavelle Parish/Faith Community Nurse Coordinator, nurse experts from across the country. In Virginia, the Natalie D’Itri, MSN, RN, AOCN Valley Health course is offered annually at Shenandoah University, Goodlett McDaniel, editor in Winchester. Martha Erbach, RN, MEd, MSN has led What is Faith Community Nursing? Commonly the SU course for nearly 15 years, and was contributor This is my experience with two kidney stones. The called parish nursing, this professional specialty in developing the 2004 revision of the IPNRC’s core first one happened when I was a driver for FedEx. It practice recognized by the American Nurses curriculum. On-line parish nurse courses exist, but as rattled around inside me for 13 weeks, finally driving Association since 1997 focuses on whole-person an attendee of the Shenandoah University program, I me to the extreme measure of having it broken up health; that is, care of the body, mind and spirit, cannot imagine forfeiting the spiritual enrichment that by minimally invasive micro-surgery, performed in a with particular emphasis on spiritual well-being. comes through fellowship with other participants in a hospital. It should be noted that access to the repair The integration of faith and health is the essence of class format that includes worship and reflection. was gained through the groin/ureter. There was this unique and wonderful nursing practice. The Education on faith community nursing practice after-care to remove a stent which was used to keep Standards and Scope of Parish Nursing was published is ongoing, and the development of a sound health the affected ureter open. by the ANA in 1998. The registered professional nurse ministry within a congregation requires recognition The second stone happened when I was no working in this ministry must work according to the that it takes time and careful planning. It is longer working and had no health insurance. I had nurse practice act of the state in which she/he is important (and sometimes challenging) to establish exhausted everything in our medicine cabinet that practicing, and comply with the identified standards an appropriate understanding that the parish nurse’s could deal with the pain. If you have never had a of practice. care of the “whole person” includes other than the stone, you don’t really know pain. My wife dug out Developed by Lutheran minister, Dr. Granger provision of physical care. A Faith Community Nurse one of our herb books and showed me a recipe from Westberg in the early 1970’s, parish nursing offers does NOT provide hands-on care; rather she/he makes Heinerman’s Encyclopedia of Healing Herbs and a professional nurse ways to provide special health referrals to home health or other community agencies Spices by John Heinerman. The tea is supposed promotion services within a given faith community. to provide direct care. Optimal mental, physical to soothe irritated tissues and help break up or Dr. Westberg recognized the church has promoted and spiritual health is promoted by the FCN who partially dissolve the stones, while the oil taken health and wholeness for centuries through worship, performs/coordinates different services based upon the afterwards acts as a lubricant to remove them from music, sharing and caring, and that it is the only congregation’s needs. The seven primary functions of the body more easily. human institution in our society that interacts with the FCN include integrator of faith and health, health Preparation of this tea consists of boiling 4 cups individuals from birth through death. The faith educator, personal health counselor, referral agent, of water and adding 2 tablespoons of chopped fresh community/parish nurse extends this historical trainer of volunteers, developer of support groups, and or dried burdock root. This is then reduced, covered, role of the church and synagogue in the promotion health advocate. and simmered for about 10 minutes. After which, this of health and wellness. A Faith Community Nurse Registered nurses working in an acute care setting mixture is removed from the heat and 3 teaspoons (FCN) is the visible presence of an intentional health will find the faith community nurse course beneficial chopped fresh or dried catnip herb are added. Let ministry, complementing the work of the clergy and for gaining increased knowledge and understanding this steep for 1 and ½ hours then strain. each cup, ministerial team. of spiritual care. JCAHO requirements include add 1 teaspoon of lemon juice and a ½ teaspoon of The FCN is a registered nurse who has had addressing our patients’ spiritual needs, but those in pure maple syrup or blackstrap molasses to sweeten, additional educational preparation in wholistic Parish Nursing know that the need for care of the spirit and drink slowly. Exactly 10 minutes later, consume ministry. Most nurses aren’t familiar with the is everywhere. ◆ 1 tablespoon pure virgin olive oil. theological perspectives on health and healing, or Instructions are to repeat this regimen 3 times with working in a congregation. Preparation for Note: The 2008 Interfaith Basic Educational Preparation in Faith Community Nursing at Shenandoah University takes each day. Importantly, it is recommended that no the role is through attendance at a basic education place April 16-19 and May 29-31. Interested RNs may contact greasy, fried foods, soft drinks, refined carbohydrates program that uses a standardized core curriculum. The Reen Markland at 540/536-5942, rmarklan@valleyhealthlink. (such as white flour or white sugar products), red curriculum was developed through the International com or Martha Erbach at 540/665-5505, [email protected] meat or poultry be consumed during the treatment. Based on my experience, this recipe for a burdock & catnip tea turned out to be a great remedy for getting rid of the stubborn kidney stone. I drank my cups of this tea, and collapsed into bed that evening, still wracked with pain. The pain (and supposedly the stone) was gone in the morning. I know this proves nothing, but if you were to someday find me in the throes of a 3rd stone, insured or not, I’d be down by the ravine looking for some burdock. ◆

REFERENCES Heinerman, John. (1996). Heinerman’s Encyclopedia of Healing Herbs and Spices. Parker Publishing Co, pp. 104, 496. The author offers this recommended reading: The Green Pharmacy (St. Martin’s Press, 1997) by James A. Duke, PhD Note: The author resides in Black Hammer Township in Southeastern Minnesota. This content is based on the author’s personal experience. www.VirginiaNurses.com Vi r g i n i a Nu r s e s To d a y —Ma y , Ju n e , Ju l y 2008—Pa g e 11 Practice Information Want to learn more about environmental The Need To Go Green health? Check out these resources: by Theresa Gaffney, BSN, MPA, RN Maryland School of Nursing. Body Burden—The Pollution in Newborns Commissioner of Workforce Issues Hospitals for a Healthy Environment (H2E) is A benchmark investigation of industrial a collaborative effort between the Environmental chemicals, pollutants and pesticides in Artificial Turf: Hazardous to Protection Agency, American Hospital Association, umbilical cord blood—http://archive.ewg.org/ Your Health? American Nurses Association and Health Care reports/body burden2/newsrelease.php Fox Business, April 18, Without Harm that promotes environmentally Nurses’ Health and Workplace Exposures to 2008 sustainable practices and pollution prevention in Hazardous Substances—http://www.ewg.org/ Traces of Drugs in Drinking healthcare facilities which ultimately saves money. sites/nurse_survey/analysis/main.php Water Prompts New To support such efforts, simply remember the 3 “Rs”– Tox Town–Environmental health concerns and Rules—National Post, Reduce, Reuse, and Recycle. For example, nurses toxic chemicals where you live, work and Canada, April 18, 2008 across the nation have initiated innovative programs play—http://toxtown.nlm.nih.gov/ Help Keep Drugs Out of to reduce the use of equipment containing the toxic The Luminary Project–lluminating stories of Water supply—Lexington chemical DEPH in neonatal intensive care units, nurses’ activities to improve human health by Minuteman, March 25, repackage hospital supplies in an environmentally improving the health of the environment. 2008 Th e r e s a Ga f f n e y conscious manner, and recycle mercury filled http://www.theluminaryproject.org/ ◆ Hormonal Problems Might batteries. But more needs to be done! be Linked to Chemical in How can you get involved? Plastic Bottles—USA Today, April 15, 2008 1. Learn about hazardous chemicals. Nurses Chemical Exposure Studied—The Journal 2. Establish a waste reduction team in your Gazette, December 19, 2007 facility. NURSE FATIGUE These are just a few of the media headlines we 3. Create a comprehensive chemicals policy in Research indicates that nurse fatigue results in have been treated to during the past 4 months. In your facility. slowed reaction time, lapses of attention, errors of our homes, communities and workplaces we are 4. Reduce hazardous substances in your facility. omission, and diminished problem-solving ability. exposed to a rapidly growing array of hazardous 5. Provide training on the health and safety risks A study by Anne Rogers, PhD, RN, FAAN, further substances. Toxic chemicals in our workplaces can that may be posed by potential hazardous indicates that medication administration and include cleaning chemicals, anesthetic gases, and chemical exposures in the workplace to all procedural errors are the most common types of medications while in our homes and communities employees. errors reported by nurses as a result of fatigue. The we are exposed to high levels of radon, lead, and 6. Support VNA’s Environmental Health Task Virginia Nurses Association (VNA) is actively involved mercury. Force! in expanding the science in the area of nurse fatigue Nurses understand the link between health and The newly created VNA Environmental Health and its impact on patient safety and is excited to the environment and are well positioned to make a Task Force will coordinate nursing’s effort to develop collaborate in a research study being conducted in difference. On March 8, 2008, more than 40 nurses and implement strategies to create ecologically the Grado Department of Industrial and Systems gathered to discuss strategies to become better sustainable environments in our homes and Engineering at Virginia Tech. This study will stewards of the environment and create healthy workplaces. Workshop participants offered priority evaluate nurses’ perceptions of their mental and healing healthcare environments for both nurses areas of focus for the task forces’ inaugural efforts physical performance. We invite you to participate and patients. such as partnering with Schools of Nursing to by completing a short survey intended to measure According to the findings of the first ever offer environmental health education for students, nurses’ perceptions about work environment, fatigue, national survey of nurses’ exposures to chemicals, exploring legislative/policy initiatives, promoting and work performance. The survey can be found at pharmaceuticals and radiation on the job, released “green meetings” and establishing “green teams” in www.virginianurses.com ◆ in December 2007, by Health Care Without Harm hospitals. (HCWH), there are links between serious health problems of nurses such as cancer, asthma, miscarriages and children’s birth defects and the duration and intensity of exposures to hazardous substances. “Nurses ingest, touch or breathe residues of any number of these potentially harmful substances as they care for patients, day after day and face potential but unstudied health problems as a result,” said Jane Houlihan, Vice President for Research at Environmental Working Group. Seventeen percent of healthcare workers are sensitized to latex and the number of nurses with latex allergies is on the rise. “For many of the toxic chemicals in hospitals there are safer alternative or safer processes. We must make these healthier choices for the sake of our patients, nurses and all hospital employees,” said Barbara Sattler, RN, DrPH, FAAN, Professor and Director of the Environmental Health Education Center at the University of Pa g e 12—Ma y , Ju n e , Ju l y 2008—Vi r g i n i a Nu r s e s To d a y www.VirginiaNurses.com Practice Information

Center: What has been your hospital’s greatest New Patient Care Innovations in a Holistic Environment: challenge in the planning and implementation of the Planetree model? The Planetree Model… featuring an interview with Ms. Sharkey: This is a total culture change: the Planetree model is woven into everything that we do; Linda Sharkey, MSN, RN it was instinctive for staff to say they ‘already do it’ by Amanda Rosenkranz, MSN, RN information. Treating our patients with dignity, regarding incorporating Planetree principles into Reprinted with permission from the Center for respect and providing information needed for patients patient care. The culture change involved saying how American Nurses to care for themselves. Forward-thinking institutions we were going to achieve a holistic model: changing whose physical environments, policies and practices visiting hours, upholding patient rights and being Linda Sharkey has worked in a variety of acute reflect a commitment organization-wide to providing there for the patient. It is a never-ending journey. care settings as a hospital supervisor, nurse manager healthcare the way the patient wants it delivered can Center: What would you tell nurses about what for reviewers of defense malpractice cases, assistant make changes, such as creating nursing stations with they can do to implement changes that embrace the director and director. In 2003 she joined Fauquier lower walls and counters to promote an environment Planetree philosophy? Health System and is Vice President of Patient Care that is void of barriers. Care partners, whether they Ms. Sharkey: The nursing leaders need to embrace Services/Chief Nurse Executive. She currently serves are family members or friends, are encouraged to help the philosophy and support their staff as they learn on the boards of the Fauquier Free Clinic, Piedmont guide the patient through the hospitalization process about the model. Some of the actions nursing leaders Home Care, and the American Organization for and advocate for the patient to care for themselves. can take are having their staff educated on how the Nurse Executives. Ms. Sharkey received Inova Integrative therapies are also used, such as pet individualized care model improves patient outcomes. Health System’s Manager of the Year and Innovation therapy, massage and yoga. Community assessments In addition, all departments and staff need to engage awards in 2002, was a finalist in Nursing Spectrum’s determine the services that are offered. in adopting the Planetree philosophy since we all play “Advancing and Leading the Profession” nursing Center: What factors influenced your hospital to a part in the patient’s care. excellence award in 2007 and received the Planetree adopt this model? Center: What has been your hospital’s greatest Spirit of Caring Award in 2007. She has served in a Ms. Sharkey: It was the right thing to do for our challenge in adopting the Planetree model? key position during the planning and implementation patients, staff and community to meet their individual Ms. Sharkey: Educating all staff on how they are a of the Planetree model at Fauquier Hospital in needs in a healing environment. In addition, it part of the Planetree philosophy and embracing it. We Virginia, which is a patient-centered holistic approach provides a competitive edge and is recognized by Joint are all one big team and we need to make sure we can to healthcare. In 2007, Fauquier Hospital became the Commission (in the form of a special quality award for deliver what we say we will deliver. fifth hospital internationally to become a Designated exceeding accreditation standards). Center: What is your vision for nursing regarding Planetree Patient-Centered Hospital. Center: What planning was needed to implement making changes to promote a healthy work We recently talked with Ms. Sharkey regarding the the Planetree model? environment? Planetree model and what nurses can do to implement Ms. Sharkey: There was a strategic alignment Ms. Sharkey: We need to look at the patient as a some of the changes that promote this individualized around this philosophy: staff and team retreats were person with feelings and look at the whole person. patient care environment. completed and a steering committee was created Nurses also need to examine how we take care of Center: Can you explain the guiding principles with staff included. The plan involved a grass roots each other, what nurses do really matters and needs behind the Planetree model? approach with the staff. During the planning, there to be recognized. We have a wellness center for staff, Ms. Sharkey: A guiding force behind the Planetree was construction so there was an architectural and our next step is to create a concierge service that model is to restore autonomy to the patient in making adaptation of this philosophy. For example, all of our takes care of all of the things nurses do on their days their own healthcare decisions by providing them rooms are private, with a day bed for family to stay off (groceries, dry cleaning). It’s important that we in the room with the patient. There is also a kitchen take care of our own staff so that they can take care located on each unit for patients and families. of our patients, families and community. ◆ www.VirginiaNurses.com Vi r g i n i a Nu r s e s To d a y —Ma y , Ju n e , Ju l y 2008—Pa g e 13 Practice Information drug that she was using and whether or not it was The Jury Is In and the Verdict Is...... approved for that use! ©April, 2008 Andrea J. Sloan, R.N., Esq. been adversely affected. So, with that in mind, it is not surprising that the The Verdict Jury was significantly more divided on the issues of Ladies and Gentlemen of the Jury... The jury was not unanimous. A few nurses were intentional and constructive fraud. Thank you for your service. Many of you called, prepared to let Violet off “with a stern warning.” Was Violet liable for intentional and e-mailed and responded to the article on Violet Was Violet negligent? Did she have a duty of care constructive fraud? Did she intentionally fail to tell the BSN, RN, who began working for a group of to Walt? Did she breach that duty by violating one or Walt that the drug was not approved by the FDA for dermatologists and plastic surgeons. The office more standards of care? Were the resulting injuries any use? Did Violet fail to tell him that she was not website promoted her as the “sclerotherapy nurse” to him caused by her failure? Was he damaged as a licensed to diagnose and treat medical conditions? and dubbed her practice of spider vein treatments result? Did her failures cause Walt to agree to undergo the as [“shrinking” Violet’s] “You’re So Vein” clinic. As YES procedures and was his consent detrimental to him? part of her contract, Violet negotiated a fee splitting Was Violet negligent per se? Did she violate YES and NO arrangement with the physicians. state statutes? Was Walt harmed as a result of such My sense from reading the comments was that the Violet treated Walter Scott, a 40 year old single guy, violations? nurses responding genuinely believed that Violet did with a significant family history of vein problems. YES not intend to deceive Walt. But, they did not seem Walt is also an avid runner, climber, skydiver, bungee Was Violet practicing medicine without a to take into account any responsibility on Violet’s jumper and white water rafter. She examined Walt’s license? part to find out whether the drug was approved for legs and told him he had [telangectiasis] spider veins. YES the procedure she was doing. The nurses seemed to No physician was involved in the assessment of Or, can a nurse diagnose a medical condition, such overlook the individual responsibility on Violet’s part Walt. He saw only Violet during both visits. Other as spider veins, select a treatment modality, provide to know the limits of her practice or to make a diligent than noting that he had no known allergies, Violet informed consent, prescribe and use a drug for an effort to find out whether what she was doing was did not take a nursing or other history or consult a intravenous injection and recommend post-operative within the scope of nursing practice. In other words, physician. Violet made the determination that he had treatment and care.... within the scope of nursing, all she could not intentionally violate the Nurse Practice spider veins, as opposed to some other pathology. without any consultation or input by a physician? Act if she did not know what it said! Violet decided to perform sclerotherapy. Violet NO One comment that was frequently seen was the selected the agent, strength, dilution and dose to Was Violet practicing beyond the scope of her vagueness of the Virginia Law. Nurses want to know be used and determined the number and site of the RN license? what constitutes the practice of nursing. But the law injections. Violet explained the risks and benefits of YES is unclear and imprecise. Virginia provides few, if any, the procedure1 and Violet witnessed the “Operative” Was Violet liable for the use of a misbranded advisory opinions, unlike some other states. Sadly, permit. Violet determined the charges for the drug in violation of federal law? Should she be nurses often wait until they are before the Board in procedure based on her fee splitting arrangement with liable for using a drug that is not FDA approved an investigation to learn the Board’s position on their her employers and recorded them in the chart. After outside of a bona fide research protocol? practice. the procedure, Violet gave Walt follow-up instructions YES Damages? and a recommendation for compression stockings. Some nurses commented that Violet was wholly If any of the above answers are yes, how much Within a week, Walt was back at the office ignorant of anything about research protocols, which would you award Walt in damages? [Assume complaining of ankle edema and pain and blistering is also apparent. that he had $25,000 in medical expenses, plus at one of the injection sites. Walt was then referred Interestingly, some nurses did not agree, stating pain, suffering, emotional distress, permanent to one of the physicians. Ultimately, Walt suffered that since Violet was not intentionally or knowingly disfigurement and permanent loss of range of motion from moderate to severe ulceration at one of the sites. using the drug in violation of the statute, she should and loss of the enjoyment of recreational activities.] He required several months of treatment and two not be held liable. In other words, they did not believe For the most part, the Jury was not very surgeries. He now has permanent scarring at the site that she had any responsibility to know about the sympathetic to Walt. Compensatory damages are and sustained mild, but permanent, decreased range of motion in the ankle. His ability to run and climb (continued on page 14) and participate in many of his athletic activities has Pa g e 14—Ma y , Ju n e , Ju l y 2008—Vi r g i n i a Nu r s e s To d a y www.VirginiaNurses.com Practice Information

The Court has jurisdiction or authority over civil delivery of a healthcare item or service, (2) Federal The Jury Is In and the Verdict Is . . . and criminal matters. In this case, the complaints of (continued from page 13) or State criminal convictions against healthcare negligence and negligence per se were civil complaints. providers, suppliers, or practitioners related to the The allegations of fraud and violations of the Virginia delivery of a healthcare item or service, (3) actions by Consumer Protection Act are also civil matters. The those damages which compensate or pay back the Federal or State agencies responsible for the licensing Court, through the jury, can only decide on those injured party for losses including medical bills and and certification of healthcare providers, suppliers, or matters over which it has authority or jurisdiction. pain and suffering. Compensatory damages are practitioners, (4) exclusions of healthcare providers, The lawsuit brought by Walt dealt only with the civil usually related to what the injured party can prove suppliers, or practitioners from participation in matters. The plaintiff, Walt, has the burden of proving by showing medical bills (Walt’s were $25,000), Federal or State healthcare programs, and (5) any his case by a preponderance of the evidence. lost wages, etc. Punitive damages are punishment other adjudicated actions against healthcare providers, If the Commonwealth’s attorney or a Federal damages, awarded with the idea of deterring this type suppliers, or practitioners. HIPDB information is attorney, a United States Attorney, determined that of conduct in the future. Punitive damages are not available to Federal and State Government agencies, Violet had violated any criminal statutes, the attorney, necessarily related to the actually provable damages health plans, healthcare practitioners/suppliers (self- on behalf of the Commonwealth or the United States and are related to the injured party proving some query), and researchers (statistics only). Similar to would bring a criminal action against Violet in the intentional and wrongful conduct on the part of the the NPDB, the HIPDB is prohibited from disclosing appropriate court, which did not occur in this case. defendant. specific information on a practitioner, provider, or The Commonwealth or United States has the burden One juror awarded $4 million in compensatory supplier to the general public. of proving, usually beyond a reasonable doubt, that damages and 1 million in punitive damages. Most So, if criminal actions were taken and Violet was Violet acted in violation of a specific criminal statute awards were much smaller, with about half the convicted, then the BON would be notified via HIPDB (law). The penalties are set out in the statute, itself, respondents not awarding any punitive damages query. Likewise, if a jury found Violet liable and and can include fines or imprisonment. Certain whatsoever. The awards overall failed to take into there was a PAID malpractice action, judgment or statutes dealing with Medicaid/Medicare billing (not account the legal expenses accrued by Walt in filing settlement, a report would be made to HIPDB and the applicable here) also include a provision for excluding his suit, such as attorneys’ fees and expert witness BON would learn of the action. a healthcare provider from participating or even from fees. Consistent with the verdict, few jurors awarded But, BON action on a license is not “automatic.” working for an employer who receives state or federal any damages under the Virginia Consumer Protection Based on any report in the HIPDB or NPDB, the Medicaid/Medicare funding as a penalty. Act. BON would initiate its own investigation and the Some jurors suggested that Violet should lose her nurse would receive her due process rights under the Other Remedies license, although one suggested “a stern warning.” Virginia Administrative Procedures Act. A number of jurors mentioned that the physicians Jurors cannot make decisions about the license of a As you may have surmised, this series of events should also be held accountable for allowing her to professional. The Board of Nursing [BON] (or, for the can be very time consuming. The lawsuit itself may practice in this manner. This nurse was employed physicians, the Board of Medicine) has the exclusive likely take years. If Violet appeals a negative verdict, by the physicians group, even though she was authority to grant licenses to professionals. Likewise, additional years pass before any payment may occur. compensated based on a percentage of fees generated. the Boards have the exclusive authority to take all If Violet were found liable under only the Virginia The legal concept of “respondeat superior” or “let the and any actions against practitioners’ licenses. Consumer Protection Act, would HIPDB even apply? master answer” means that the employer is legally But, is this action automatic? The answer is NO. Perhaps not. Then, the BON investigation may responsible for the acts of the employee done within First the Board has to find out about the jury’s verdict take additional time. Meanwhile, Violet has had an the course and scope of employment. or the criminal conviction. The National Practitioner unrestricted license to practice. In this case, the employer physicians were aware of Data Bank (NPDB) and Healthcare Integrity and Note that any of the parties could notify the BON Violet’s actions and should have been aware of the fact Protection Data Bank (HIPDB). are alert or flagging at any time, even before the filing of the lawsuit. that she was in violation of the Nurse Practice Act. systems intended to facilitate a comprehensive Under Virginia Code §54.1-2408.1, any health Recall that in Virginia a nurse practitioner must have review of the professional credentials of healthcare regulatory board may suspend the license, certificate, a practice agreement with a physician for prescriptive practitioners, providers, and suppliers. registration or multistate licensure privilege of any authority. The NPDB contains information on the following person holding a license, certificate, registration, Would you believe that the doctors did not support actions against physicians and dentists: (1) adverse or licensure privilege issued by it without a hearing Violet? Their attorneys argued that Violet should have licensure actions; (2) clinical privileges actions, simultaneously with the institution of proceedings known her actions were in violation of the Nurse and; (3) professional society membership actions. In for a hearing, if the relevant board finds that there Practice Act and that they, as physicians, were not addition, the NPDB contains the following actions is a substantial danger to the public health or safety responsible for any of her actions which violated the against physicians, dentists and other healthcare which warrants this action. Institution of proceedings law. practitioners: (4) paid medical malpractice judgments for a hearing shall be provided simultaneously with Curiously, no juror suggested that the doctors be and settlements; (5) Exclusions from participation in the summary suspension. The hearing shall be reported to the Board of Medicine for allowing the Medicare/Medicaid programs, and; (6) registration scheduled within a reasonable time of the date of the nurse to practice outside the law. Some of the jurors actions taken by the U.S. Drug Enforcement summary suspension. did hold them financially accountable for some of the Administration (DEA). State licensing authorities, Several jurors stated that if Violet had been damages awarded. healthcare practitioners (self-query), researchers “certified” to do sclerosing therapy, she would not have (statistics only), and in limited circumstances, Board of Nursing Action? had any of these problems. Certified by whom? What plaintiffs’ attorneys. A number of jurors did suggest that the nurse’s is the relationship between certification and the Nurse The intent of the HIPDB is to combat fraud license be revoked by the Court. This suggestion is Practice Act? To be continued.... ◆ and abuse in health insurance and healthcare troubling in that it indicates a lack of understanding Andrea J. Sloan is a nurse and an attorney whose delivery. The HIPDB contains the following types of about the role of the Courts and the Board of Nursing. practice includes healthcare law, employment law (including information: (1) civil judgments against healthcare representation of professionals in disciplinary proceedings) providers, suppliers, or practitioners related to the and bioethics. Comments and questions are invited. 1350 Beverly Road, #115-123, McLean, VA 22101-3961 or e-mail at [email protected]. 703.438.9201, 703.438.9201 fax. 1 Informed Consent? By a nurse? Pa g e 16—Ma y , Ju n e , Ju l y 2008—Vi r g i n i a Nu r s e s To d a y www.VirginiaNurses.com Practice information The LEAD Summit 2008 proudly presents: Dr. Audrey make our patients who are at risk more active. If we start to look at how we should get our patients more Nelson and Cracking the Code of Patient Falls active and mobile, while providing environments that prevent fall-related injuries rather than preventing by Diane E. Scott, RN, MSN opportunities in patient safety. He convinced me my falls, I think we can finally make significant progress Reprinted with permission from the Center for work in functional outcomes was closely matched to in this area. American Nurses preventing adverse events, and so my research area For example, imagine a nursing home or a rehab was redefined to include patient safety. center that looks at the environment, and floor The Center for American Nurses is exceptionally In 1999, when the Institute of Medicine released surfaces, which will prevent injuries when a person proud to have Dr. Audrey Nelson, a nationally known its report, To Err Is Human: Building a Safer Health is becoming more active. If we change our paradigms expert and researcher in the field of patient and System, patient safety and the reduction of errors and increase mobility with the at-risk populations, caregiver safety, as part of the LEAD Summit 2008. made front-line news. Fortunately, I already had we may see an increased fall rate, but falls with less Dr. Nelson has multiple awards, including the first a patient safety center and had a head start in significant injuries. This is because of a focus on fall Magnet Prize Award for Innovation in Patient Safety developing research to focus on this now very-public protection and being proactive with increasing the and the John Eisenberg Award for Individual Lifetime issue. mobility of the patients, which promotes health and Achievement in Quality and Patient Safety. The Center: Could you provide an overview of your quality of life. Eisenberg Award, established by the National Quality research related to the patient safety movement Center: During LEAD Summit 2008, you Forum (NQF) and The Joint Commission, recognized and patient falls? are going to speak to the needs of safe patient Dr. Nelson for her tireless efforts in magnifying the Patient safety is a very broad subject and with handling and the bariatric patient. What scope of practice for patient safety and advocacy for many different foci. Part of our success was to drill do you see as the greatest challenge in the those with disabilities. down deep in one area—preventing adverse events implementation of safe patient movement With over 30 years of nursing experience, associated with mobility/immobility. These are high techniques and strategies in today’s healthcare including the roles of staff nurse, nurse cost, high volume problems in nursing. One of the settings for the unique needs of the bariatric administrator, and nurse researcher, Dr. Nelson is adverse events we have focused on is patient falls. patient? currently the Director of the Department of Veterans Other areas include wandering, pressure ulcers, and Obesity is an incredible rising problem within the Affairs (VA) Patient Safety Center of Inquiry, safe patient handling. United States and is becoming a crisis for healthcare supervising over 63 research staff and a total budget Center: How will attending this conference organizations and the nurses who care for these exceeding $15 million. help nurses acquire strategies to reduce the risk patients. The Center for Disease Control’s website To find out more about what attendees will learn of falls among patients? shows, state by state, the rate of obesity among the from her presentation at the LEAD Summit, 2008, One of my favorite things to do is to take a United States populations throughout the past years, we talked with Dr. Nelson about her work. complex nursing practice problem with thousands of and how it demonstrates an epidemic. Center: You have been nationally recognized as journal articles written about it and to help develop Nurses have not been equipped to deal with this a pioneer in patient safety, how did you initially solutions with research based practice. Attendees population in a dignified way. Obese patients are become involved in patient safety research and at this conference will examine past paradigms very vulnerable as a result, both emotionally and the patient safety movement? of looking at patient falls. I hope to change their physically. Even normal nursing activities place Beginning in 1980, I started my work focusing perspectives of this issue and strategically consider nurses and patients at risk because simple nursing on the functional outcomes in persons with a spinal different interventions designed to increase patient interventions are physically challenging. cord injury. During this time, I focused primarily safety. My talk at LEAD Summit 2008 is going to focus on rehabilitation outcomes and research within this With patient falls, we have over three decades on standardizing nursing practices for the bariatric specialty population. of research, yet we have never ‘cracked the code’ patient and describing technological innovations. I In 1998, Dr. Robert H. Roswell, who then to prevent patient falls. During the conference we am thrilled to present at this conference and hope was the Director of VISN 8 (Veterans Integrated will strategically examine whether our focus on that attendees will gain a greater appreciation of Services Network), approached me about research preventing falls has actually jeopardized patient their roles as nurses and leaders in safe patient safety, by encouraging nurses to chemically or handling. mechanically restrain patients so they would be safe. Attendees at LEAD Summit 2008 will have the We inadvertently prevented our patients from being opportunity to hear more about Dr. Audrey Nelson’s active and mobile, and interfered with quality of life. groundbreaking work on patient falls and safe patient Now, in retrospect, I firmly believe that good handling. For more information about LEAD Summit, quality of care means something needs to happen to please visit www.leadsummit2008.org. ◆

www.leadsummit2008.org

Transforming Work Environments: Centered by Vision...Powered by Knowledge June 23-24, 2008 | Washington Hilton Hotel, Washington, DC

The educational opportunities presented at LEAD Summit 2008 will offer a wealth of resources to improve your workplace while enhancing patient care delivery. Timely plenary and poster sessions will focus on key topics of staffing, workflow design, personal social factors, physical environment, and organizational / cultural factors. Join your nursing colleagues to: • Explore state of the art innovations and approaches to building • Elevate and advance leadership skills and practices for success in healthy environments that enhance and promote quality patient care. today’s healthcare environment. • Examine the latest information on evidence-based nursing practices • Network with nurse leaders from across the country who share to advance knowledge of nurses at the bedside. your passion for creating optimal environments for patient care • Investigate effective strategies to address disruptive behavior and and for nurses. bullying in the workplace.

Don’t miss this innovative conference. Early bird registration available through April 15, 2008. www.VirginiaNurses.com Vi r g i n i a Nu r s e s To d a y —Ma y , Ju n e , Ju l y 2008—Pa g e 17 VNA — Working for you

Outstanding Member Nomination For Award Outstanding Member Guidelines/Application Award For The Year 1. The award is presented on an alternating Name:______schedule with other VNA awards. Solicitation deadlines will be posted to invite nominations. Year Joined VNA ______The award will be presented at the October 25, 2008 meeting of the Delegate Address:______Assembly. 2. Nominations must be submitted to the Employment:______Chairman of the Council of District Presidents no later than August 31, 2008. Mail or send VNA ACTIVITIES: by email to the VNA office at kmahone@ virginianurses.com Offices Held______3. The award may be given to a member only once. Committee Service______4. Nomination process: • Complete the appropriate Nomination form Other______accompanied by a current vitae or resume of the individual being nominated. ANA ACTIVITIES (or activities in another state • Submit either a letter or other nurses’ association): documentation (ie: a newspaper article; relevant letter from a third party), which Offices Held______supports at least 6 of these criteria: a. positive interpersonal relationships with Committee Service______peers and VNA b. enthusiasm and role modeling Other______c. leadership abilities d. integrity e. dedication to profession OTHER PROFESSIONAL ACTIVITIES: f. upholds Code of Ethics g. community activities Offices Held______h. professional activities i. willingness to take a stand on Committee Service______professional issues j. mentoring activities Other______k. innovative ideas l. special COMMUNITY ACTIVITIES:

Deadline Date:______Date:______Name:______

Address:______

VNA District:______

E-Mail Address:______

Place of Employment:______

Work Address:______

RN License #______

Individual Submitting Nomination:______

______

VNA District:______

Day Phone:______

E-Mail Address:______Pa g e 18—Ma y , Ju n e , Ju l y 2008—Vi r g i n i a Nu r s e s To d a y www.VirginiaNurses.com news at a glance

Centra Health and The Health Care Career Center TNCC Receives Grant from by Kim Price, RNC, MSN, MBA Williamsburg Community Health Director Women and Children’s Services Foundation to Strengthen Health Centra Health, Virginia Baptist Hospital Lynchburg Virginia Care Workforce Initiatives

In Lynchburg, Virginia, The Williamsburg Community Health Foundation a community collaboration has awarded $85,000 in grants to the Thomas between our nurses, Nelson Community College Educational Foundation, Alumnae Associations, and Inc. to strengthen healthcare workforce initiatives our local Legacy Museum of at the College. One grant of $60,000 will provide African American History scholarships for TNCC nursing and other allied of Lynchburg and Central health students while another totaling $25,000 will Virginia has resulted in a support a Health and Medical Services Pathway new and exciting exhibit in project that targets Historic Triangle area high the “The Healthcare Career Image of Office school students. Center.” A three-year grant, the nursing and allied health Centra’s nursing staff scholarship funds will be provided to the College P. Wh i t e h e a d helped raise over $75,000 to operating room. at $20,000 each year to help current students support the establishment Centra also showcases the history of nursing in offset the costs of their education. To be eligible for of this unique Center. It was constructed as an the area and feature the various schools of nursing a scholarship, students must be either employed innovative space within the hospital that provides and how nursing education has changed over the by Eastern State Hospital or a local healthcare school groups and others the opportunity to learn years. The exhibits demonstrate how some aspects facility or be a resident of the greater Williamsburg about the history of nursing in our community and of nursing education have not changed since the community. The grant will also assist graduating options for nursing education and careers. This hospital opened in 1924. The healing touch, caring TNCC nursing students who will enroll in Bachelor center showcases available healthcare careers as for our patients, “always putting the patient first”-are of Science in Nursing Programs at four-year colleges interactive computers and videos show the many themes they want to instill in future generations of and universities in Virginia. faces of nursing. nurses. The second grant will enable TNCC to partner The newest exhibit in the Center highlights the There is also a ‘grab and go’ exhibit for a speakers with Williamsburg/James City County high schools African American healthcare professional. This bureau of nurses to use when we are asked to to strengthen the career path in health sciences exhibition describes the diverse careers of African present at school career days. The Center is open to for young students; thus, the College can meet the Americans who provided healthcare in Lynchburg the public daily and special tours are available by region’s need for trained healthcare professionals as and the difficulties they faced in achieving their appointment for local school groups. the Health and Medical Services Pathway project can goals. It was produced by the Legacy Museum of This space will serve to educate young people lead to a two-year degree or industry certification for African American History in June 2000 as their about the rewards of healthcare careers. A virtual students. Funds provided by the grant will purchase inaugural exhibition with support from the Centra tour of the Healthcare Career Center is available at instructional materials, supplies, and equipment Health Foundations. www.centrahealth.com. ◆ such as manuals and anatomical models. The grant For two centuries African Americans in Virginia will also cover some of the project’s marketing and have relied on remedies made from plants and used promotional costs. charms and medicines passed down from African CE Fees Thomas Nelson’s Educational Foundation, traditions to care for themselves and their loved a private, nonprofit, tax-exempt organization, ones. Formal medical training for African Americans Continuing Education Approval (CEA) Committee enhances access to higher education opportunities as doctors, nurse pharmacists and dentists were of the VNA is an accredited approver of continuing at the College by reducing financial barriers for restricted by segregation laws to institutions like education by the American Nurses Credentialing students. Also a non-profit, private organization, Howard University and Meharry School of Medicine Center (ANCC). The tasks of this body include the Williamsburg Community Health Foundation that were established after the Civil War. reviewing provider applications, and approving strives “to improve the health of the people living During this time in Lynchburg, African American educational activity applications for conferences. in Williamsburg and surrounding counties in doctors were excluded from practicing in hospitals The CEA Committee accomplishes these important collaboration with community partners” through its and were confined to general office practice in tasks through the dedication of loyal and diligent grant making. black neighborhoods, while public health nurses committee members who volunteer their time and For more information about the scholarships, faithfully cared for school children and African talent. please call the College’s Scholarship Office at (757) American citizens who were unable to afford private After careful consideration the CEA Committee 825-2848 or contact the Educational Foundation at doctors. Healthcare and health educations remained is redefining how the fees for CE approval (single 825-2719 for other details about the grants. ◆ segregated until the 1964 Civil Rights Act and the activities) will be calculated. Beginning on June, 1, establishment of Medicare and Medicaid in 1965 2008, the fees will be based on the number of contact finally brought the divided health system together. hours reviewed , not on the number of contact hours District 2 News Today, disease and mortality rates for African the participant will receive. Americans are still relatively high, but the presence There is a $20.00 charge for each topic in a Phyillis Brown Whitehead, RN, MSN, CNS, CHPM of black health professionals in medical facilities concurrent session in addition to the contact hour and Dianna Boyd, RN, MSNc, CNS, AE-C will speak encourages more African Americans to seek fee. at Advanced Practice Nursing Conference: Care professional healthcare. Getting African Americans For example a participant may receive 7 contact Through the Ages at the Mayo Clinic, Rochester to enter the health professions remains a crucial step hours for a program, but the actual content of the Minnesota on July 24–25, 2008. to improving healthcare for all. program may be 10 contact hours. The fee for this They are discussing the Clinical Nurse Specialist In addition, exhibits allow children to experience program would be $200.00. This is most often role in Instrument Development and validation. Their the breadth and depth of nursing from the neonatal realized when concurrent sessions are provided. tool: The Comfort Scale for Mechanically Ventilated unit to hospice care. The interactive exhibits help Patients (MVES) was developed and piloted among children learn about body systems, ways to prevent Example: three critical care units. The tool contains five infections, CPR, and give students a “look” into an 8:30-9:30 am General Session (1 contact hour) dimensions rated on a three point likert scale. 9:30-10:30 am General Session (1 contact hour) Ms. Whitehead, the legislative chair for district 10:30-10:45 am Break 2 received both her BSN and MSN from Radford 10:45-11:45 am General Session (1 contact hour) University. She is certified in Pain Management and 11:45-12:45 pm Lunch Hospice and Palliative Care, having had ELNEC 12:45-1:45 pm Concurrent Sessions training in 2003. She is currently employed at Topic #1 (1 contact hour) Carilion Roanoke Memorial Hospital as a CNS in Pain Topic #2 (1 contact hour) Management and Palliative Care and is studying for 1:45-2:45 pm Concurrent Sessions her PhD in Health Promotions at Virginia Tech. ◆ Topic #1 (1 contact hour) Topic #2 (1 contact hour) 2:45-3:00 pm Break 3:00-4:00 pm Concurrent Sessions Topic #1 (1 contact hour) Topic #2 (1 contact hour) 4:00-5:00 pm General Session (1 contact hour)

Individual educational program approval; 1-4.99 Contact Hours reviewed: $75.00 5-9.99 Contact Hours reviewed: $150.00 10-17.99 Contact Hours reviewed: $200.00 18 Contact Hours & over reviewed: $225.00 plus $5.00 per each additional C.H. If you have further questions about fees charged for CE approval, please email us at vnacea@ virginianurses.com. ◆ www.VirginiaNurses.com Vi r g i n i a Nu r s e s To d a y —Ma y , Ju n e , Ju l y 2008—Pa g e 19 news at a glance

2008 Open Offices for the Virginia Nurses Association The sub-structural units are: 1. Committee on Nursing Research which shall: • Secretary 1. Continuing Education Provider Committee, a. consist of at least three (3) members • Commissioner on Nursing Education which shall: b. serve as a resource group for the research • Commissioner on Work Force Issues a. consist of at least six (6) members; activities related to the VNA • Commissioner on Nursing Practice b. act as consultants for the provider unit on c. provide consultation and information relative • One Director-at-Large continuing education programs; and to planned and ongoing research programs • Three (3) members of the Committee on c. adhere to American Nurses Credentialing and activities that would be of interest to Nominations Center (ANCC) criteria and meet all professional nurses requirements to maintain accreditation. d. identify by name, location, and area of Qualifications: interest, those professional nurses in Virginia To be eligible to serve as an officer, a member 2. Continuing Education Approval Committee who are actively engaged in research and shall hold current membership in a District and not which shall: would be willing to serve as consultants in concurrently serve as an officer or director of another a. consist of at least nine (9) members from their areas of expertise organization if such participation might result in a the various geographic areas of the state to 2. Practice Councils, which shall: conflict of interest with VNA. The terms are for two include members representing a cross section a. provide a community of peers and a principal years. of nursing practice if possible; source of expertise in areas of interest and The Secretary shall be responsible for ensuring b. assume the leadership role in promotion serve as a forum for discussion of relevant that records are maintained of all meetings of the and implementation of the ANA standards of issues and concerns Delegate Assembly, Board of Directors, and Executive continuing education for nurses; b. embrace standards, positions, and policies Committee. c. review and approve continuing education relevant for the specific area of expertise; Each Commissioner shall coordinate the activities activities and providers in adherence with c. maintain communication with the of the commission and serve as ex- officio a member of ANCC criteria; and Commissioner of Nursing Practice and other all committees that are the sub-structural units of that d. adhere to all ANCC criteria and meet units within the Association, as appropriate; commission. all requirements to maintain ANCC d. develop and evaluate a plan of operation for The Director-at-Large shall be a staff nurse who accreditation. carrying out its responsibilities; represents that constituency in all Board of Directors e. assure that its policies and positions are in business and transactions. The responsibilities of the Nursing Practice accordance with those of VNA; Commission are to: f. promote increased understanding of the Details on Commission Positions: • provide a forum for discussion of current healthcare needs of vulnerable populations The responsibilities of the Work Force Issues healthcare practice/trends and their impact within areas of expertise; Commission are to: on nursing care of individuals, groups, and g. serve as a resource regarding ethics and • provide a forum for the discussion of work force communities human rights as they relate to the specific issues, including human rights of nurses, issues • promote standards, positions, and policies areas of expertise. related to diversity, and the work environment for nursing care of individuals, groups and h. promote the contributions of nursing practice • assist nurses in developing skills to respond to communities to the health and well being of the citizens of current and emerging healthcare environments • advocate for optimal healthcare of vulnerable Virginia. • assist nurses in increasing their awareness and populations i. be established by the Board of Directors upon understanding of the dimensions of diversity, • promote ethical decision-making among nurses petition from at least thirty (30) members; including ethnicity/culture, age, gender, physical • advocate and support the systematic study and and abilities, religion, race and sexual/affectional dissemination of research in nursing with its j. be dissolved by a two-thirds vote of the orientation and their effect on client care and the subsequent application to practice Board of Directors if there is no reason for its work place continued existence. ◆ • advocate and support the systematic study of work force and diversity issues within nursing and healthcare and their subsequent application to nursing practice.

Nursing Education Commission: • identify priorities and issues for education in Virginia that are within the scope of the VNA • promote collaboration among educational groups within Virginia • promote collaboration between education and practice • implement activities to maintain accreditation of VNA’s Continuing Education Approval and Provider status The sub-structural units are: Pa g e 20—Ma y , Ju n e , Ju l y 2008—Vi r g i n i a Nu r s e s To d a y www.VirginiaNurses.com news at a glance

Biography & Consent to Serve Form for VNA Elected Officials (Offices elected in even numbered years shown in shading)

Attach Resume/Statement if additional space needed Please Type or Print:

Name:______

Address:______

Telephone (Home):______(Work):______

Employer:______VNA Member? _____ Yes _____ No

Title/Position______E-mail Address:______

VNA District:______Membership Exp. Date:______

Education: School/College______Degree/Diploma______Date______

Relevant Experience: Professional:______

Civic:______

Organizational:______

VNA District & State Levels:______

Other or additional experience can be put on the back of this page.

I wish to run for the following office of the Virginia Nurses Association. I understand the duties and responsibilities involved in this office and, if elected, I agree to serve, abiding by the VNA Bylaws, the VNA House of Delegates and Board policies and actions, and the ANA Code for Nurses.

______Secretary ______Commissioner on Work Force Issues

______Commissioner on Nursing Education

______Director At Large ______VNA Committee on Nominations (3)

______Commissioner on Nursing Practice

Here is my statement (on reverse side or separate sheet of paper) on what I think the duties and priorities for this office are and relevant experience I have had:

______Signature of Candidate Date Signature of District President/Officer Date www.VirginiaNurses.com Vi r g i n i a Nu r s e s To d a y —Ma y , Ju n e , Ju l y 2008—Pa g e 21 membership news

Welcome New & Returning Members District 1–Far SouthWest Nancy New Mary Melody Agbuya Janet Mosley Mary Nugent Christine Narad Susan Ryan Amanda Nickerson District 2–New River/Roanoke Lori Thurmond Susan Parker Teanessa Atkins Judith Rogers Laura Biscotte District 6–Mid-Southern Area Fortune Sia Linda Tate Brittany Collins Po Soo-Hoo Shari Webb Sarah White Joyce Prince Linda Schakenbach District 3–Central Virginia Andrea Summers Juwairiyah Foxx District 7–Piedmont Area Tracy Thigpen Glinda Ireland Kathleen Fletcher Lori Todd Sherry Kolb Laura Knight Mercedes Turbulencia Patti McCue Kimberly Mechling Jackie Wavelet Jacquelin Snead Karen Moore Paula Ruffin District 9–Mid-Western Area District 4–Southside Hampton Roads Travis Williams Claudia Fontenot Lynette Young District 10–Peninsula Area Janice Ganderson Janet Buser Caroline Goler District 8–Northern Virginia Nancy Johnson Andrea Kline Evita Abeleda Adriane Wallace Jessica Belz District 11–Eastern Shore Diana Yanero-Albert Kelly Davis Elisabeth Caison Mary Fulgencio District 5–Richmond Area Sophia Halpern District 12–Northern Shenandoah Valley Jonathan Bagby Kalin Herrick Sarah Bunting Andrea Barden Kathy Howey Reann Cummings Valerie Colerman Christine Hull Kathryn Zirkle Tia Jones Lauren Jost Danielle Murphy Erin Koger Pa g e 22—Ma y , Ju n e , Ju l y 2008—Vi r g i n i a Nu r s e s To d a y www.VirginiaNurses.com membership news

State Nurses Association Membership Application

8515 Georgia Avenue • Silver Spring, MD 20910 • (301) 628-5000

DATE ______

______Last Name/First Name/Middle Initial Home Phone Number

______Credentials Work Phone Number Basic School of Nursing

Preferred Contact: Home _____ Work ______Fax Number Graduation (Month/Year)

______Home Address Date of Birth RN License Number/State

______Home Address E-mail

______UAN Member? _____ Not a Member of Collective Bargaining Unit City/State/Zip County

______Employer Name _Member of Collective Bargaining Unit other than UAN? (Please specify)

______Employer Address

______Employer City/State/Zip Code

Membership Category (check one) ❏ E-Pay (Monthly Electronic Payment) Payment This is to authorize monthly electronic This is to authorize annual credit card M Full Membership Dues—$244.00 payments to American Nurses payments to American Nurses ❏ Employed - Full Time Association, Inc. (ANA). By signing on the Association, Inc. (ANA). By signing on the ❏ Employed - Part Time line, I authorize my Constituent Member line, I authorize CMA/ANA to charge the Association (CMA/ANA) to withdraw 1/12 credit card listed in the credit card R Reduced Membership Dues—$122.00 of my annual dues and any additional information section for the annual dues on ❏ Not Employed service fees from my account. the 1st day of the month when the annual ❏ Full Time Student ❏ Checking: Please enclose a check for the renewal is due. ❏ New graduate from basic nursing first month’s payment ($20.83); the ______education program, within six months account designated by the enclosed Annual Credit Card Payment Authorization after graduation (first membership check will be drafted on or after the 15th Signature * SEE BELOW year only) each month. ❏ 62 years of age or over and not ❏ Payroll Deduction earning more than Social Security ❏ Credit Card: Please complete the credit This payment plan is available only where allows card information below and this credit there is an agreement between your card will be debited on or after the1st day employer and the association to make S Special Membership Dues—$61.00 of each month. such deduction. ❏ 62 years of age or over and not ______employed ______Signature for Payroll Deduction ❏ Totally disabled Monthly Electronic Deduction Authorization Signature * SEE BELOW Please mail your completed application with your payment to VNA or to: Full Annual Payment AMERICAN NURSES ASSOCIATION Please Note: $5.42 of the CMA member dues Membership Investment ______Customer and Member Billing is for subscription to The American Nurse. $16 ANA-PAC (Optional— P.O. Box 17026 is for subscription to the American Journal of $20.04 suggested) ______Baltimore, MD 21297-0405 Nursing. Various amounts are for subscriptions Total Dues and Contributions ______to CMA/DNA newsletters. Please check with * By signing the Monthly Electronic Deduction your CMA office for exact amount. Online: www.NursingWorld.org Authorization, or the Automatic Annual (Credit Card Only) Credit Card Payment Authorization, you are State nurses association dues are not ❏ Check (payable to ANA) authorizing ANA to change the amount of deductible as charitable contributions for ❏ Visa ❏ MasterCard $10.33 by giving the above-signed thirty (30) tax purposes, but may be deductible as a days advance written notice. Above signed business expense. However, that percentage may cancel this authorization upon receipt of dues used for lobbying by the CMA is not credit card information by ANA of written notification of termination deductible as a business expense. Please twenty (20) days prior to deduction date check with your CMA for the correct amount. ______designated above. Membership will continue Bank Card Number and Expiration Date unless this notification is received. ANA will charge a $5 fee for any returned drafts or ______chargebacks. Authorization Signature Choice of Payment (please check) ❏ Automated Annual Credit Card ______Printed Name Amount: $______

to be completed by sNa: Employer Code ______Sponsor, if applicable ______STATE DIST REG Approved By ______Date ______SNA membership # ______Expiration Date ______/ ______$ ______Month Year AMOUNT ENCLOSED CHECK # membership application