an iconic nurse’s historic letter is totally relevant …...ana quality & innovation...
TRANSCRIPT
Montana Nurses Association is a PROUD supporter of HR 1309
THE OFFICIAL PUBLICATION OF THE MONTANA NURSES ASSOCIATION FOUNDATION Quarterly publication direct mailed to approximately 19,000 RNs and LPNs in Montana.
August 2019 • Vol. 56 • No. 3
www.mtnurses.org
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Executive Director Report
Vicky Byrd,BA, RN, OCN
APRN CornerPage 5
current resident or
Non-Profit Org.U.S. Postage Paid
Princeton, MNPermit No. 14
ANA Quality & Innovation Conference
Page 7
An iconic nurse’s historic letter is totally relevant today!
This letter is being shared with permission and credit to Mary Munger, RN. It was written in the 1960’s best to her recollection when the Montana Nurses Association office was located in the Wheat Building, Suite 326
in Helena. “The Wheat Building, originally owned by Merchants National Bank and once home to Montana Power’s
offices, is one Helena landmark from 1969 that is no longer standing. The building was an example of the Chicago School of architecture” (Jacobson, 2009).
Mary’s paper is completely relevant today as MNA continues to reach out to engage all Montana Nurses across the state of Montana, moreover, recognizing that it is completely acceptable to pay dues to their professional association for others (MNA staff) to advocate for them. Nurses and those staff that work closely with the MNA nurses, speak to nursing issues. Without nurse membership there would be
Executive Director Report continued on page 5
Montana Nurses Association is a PROUD supporter of HR 1309
Page 2 Montana Nurses Association Pulse August, September, October 2019
CONTACT MNAF & MNAMontana Nurses Association Foundation
and Montana Nurses Association20 Old Montana State Highway, Clancy, MT 59634• Phone (406) 442-6710 • Fax (406) 442-1841
• Email: [email protected] • Website: www.mtnurses.orgOffice Hours: 7:30 a.m.-4:00 p.m. Monday through Friday
VOICE OF NURSES IN MONTANAMNA is a non-profit, membership organization that advocates for nurse competency, scope of practice, patient safety, continuing
education, and improved healthcare delivery and access. MNA members serve on the following Councils and
other committees to achieve our mission:• Council on Practice & Government Affairs (CPGA)• Council on Economic & General Welfare (E&GW)• Council on Professional Development (CPD)• Council on Advanced Practice (CAP)
MISSION STATEMENT - MNAFPreserve the history of nursing in Montana and contribute, support and
empower the professional nurse in Montana.
MISSION STATEMENT - MNAThe Montana Nurses Association promotes professional nursing practice, standards and education; represents professional nurses; and provides
nursing leadership in promoting high quality health care.
PROFESSIONAL DEVELOPMENTMontana Nurses Association is accredited as an approver of continuing
nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
Montana Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s
Commission on Accreditation.
MNAF & MNAStaff:Vicky Byrd, MSN, RN, Chief Executive OfficerPam Dickerson, PhD, RN-BC, FAAN, Director of Professional DevelopmentMary Thomas, BA, RN, RN Professional Development AssociateCaroline Baughman, BS, Professional Development AssociateRobin Haux, BS, Labor Program DirectorAmy Hauschild, BSN, RN, Labor RepresentativeSandi Luckey, Labor RepresentativeLeslie Shepherd, BSN, RN, Labor RepresentativeJill Hindoien, BS, Chief Financial OfficerJennifer Hamilton, Administrative Assistant
Board of DirectorsExecutive Committee:Board of Directors President Lorri Bennett, RNBoard of Directors Vice President Terry Dutro, MSN, APRN, AGPCNP-BCBoard of Directors Secretary Chelsee Baker, BSN, RN Board of Directors Treasurer Audrey Dee, RNBoard of Directors Member at Large Anna Ammons, BSN, RN, PCCNBoard of Directors CPGA Bobbie Cross, RNBoard of Directors PD Cheryl Richards, MS, BSN, RN-BCBoard of Directors CAP John Honsky, APRNBoard of Directors EGW Brandi Breth, BSN, RN-BC
Council on Practice & Government Affairs (CPGA)Abbie Colussi, RN Lisa Ash, RN, CNORAnna Ammons, BSN, RN, PCCN Jennifer Miller, RNLoni Conley, BSN, RN
Council on Professional Development (PD)Sandy Sacry, MSN, RN Cheryl Miller, MSN, RN-BCGwyn Palchak, BSN, RN-BC, ACM Debby Lee, BSN, RN-BC, CCRPEmily Michalski-Weber, MSN, RN-BC Abbie Colussi, RNBrenda Donaldson, BA, RN, CAPA Kim Reynen, BSN, RN
Council on Advanced Practice (CAP)Chairperson-CAP Deborah Kern, MSN, FNPChairperson Elect-CAP Keven Comer, MN, FNP-BCSecretary-CAP Nanci Taylor, APRNMember at Large-CAP Barbara Schaff, FNP-BCMember at Large-CAP Emily Michalski-Weber, MSN, RN-BC
Council on Economic & General Welfare (EGW)Delayne Stahl, RN, OCN Krystal Frydenlund, RN, CCRNLisa Ross, RN, CCRN Adrienne Harrison, RN
Questions about your nursing license?Contact Montana Board of Nursing at: www.nurse.mt.gov
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If your address has changed please contact Montana Board of Nursing at:
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PUBLISHER INFORMATION & AD RATESCirculation 19,000. Provided to every registered nurse, licensed practical nurse, nursing student and nurse-related employer in Montana. The Pulse is published quarterly each February, May,
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Montana City, MT 59634, a constituent member of the American Nurses Association.
For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, sales@aldpub.
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errors in advertising is limited to corrections in the next issue or refund of price of advertisement.
Acceptance of advertising does not imply endorsement or approval by the Montana Nurses Association of products
advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. MNA and
the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of MNA or
those of the national or local associations.
WRITER’S GUIDELINES:MNA welcomes the submission of articles and editorials related
to nursing or about Montana nurses for publication in The PULSE. Please limit word size between 500–1000 words and provide resources and references. MNA has the Right to accept, edit or
reject proposed material. Please send articles to: [email protected]
Enjoy a user friendly layout and access to more information, including membership material, labor resources, Independent Study Library,
a new Career Center for Job Seekers & Employers, and more downloadable information.
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We are gathering articles that are relevant and appealing to YOU as a nurse. What is happening in your world today? Is there information we can provide that would be helpful to you? The Pulse
is YOUR publication, and we want to present you with content that pertains to your interests.
Please submit your ideas and suggestions to Jennifer.
“Nursing is an art: and if it is to be made an art, it requires an exclusive devotion as hard a preparation, as any painter’s or sculptor’s work; for what is the having to do with dead canvas or dead marble, compared with having to do with the living body, the temple of God’s spirit? It is one of the Fine Arts: I had almost said, the finest of Fine Arts.” Florence Nightingale
We have all witnessed ceremonies conducted at funerals for veterans, law enforcement personnel, fire fighters, etc. Maybe they were on TV or you might have been there in person. Those ceremonies not only honored the departed, but the profession. Nursing is now honored in the same way with The Nightingale Tribute and many Montana communities have adopted this to recognize the person’s lifetime of service to others.
The Honor Guard is comprised of two to four nurses wearing traditional white nursing uniforms,
capes and caps. A Nightingale Lamp is lit during the reading of the tribute to the profession. A white rose is placed on the casket or urn. There is a call relieving the nurse from duty, the candle is extinguished and presented to the family.
With the help of existing Honor Guards from both St. Patrick’s Hospital and Missoula Community Hospital, we have formed an Honor Guard in Havre reaching a radius of 50 miles beyond Havre, thus calling ourselves the Hi-Line Nurses Honor Guard. MNA provided us with some generic nurses caps and Northern Montana Hospital Local Unit bought lamps. NMH provided us a space to keep our supplies as we are aware that a location with 24/7 access is desirable. Contact was made with funeral homes and the ministerial association. A brochure was created as well as a calling list of nurses willing to serve.
We are excited about this way to honor nurses and their families for their years of dedicated service. A quote from the Tribute: “You are not remembered by your many years as a nurse, but by the difference you made during those years by stepping in and touching people’s lives….You are hereby relieved of duty. Your shift is done.”
Nurses Honor Guard
Central Montana Medical Center408 Wendell Ave. Lewistown, MT 59457
406.535.6213 (fax) 406.535.4698www.cmmc.health
RNs, visit our website at
cmmc.health to learn more about our
positions & to apply online.
CMMC is Hiring!
August, September, October 2019 Montana Nurses Association Pulse Page 3
The strength that nurses build to use their collective voice to improve wages, working conditions, and patient care comes from spending time together. Time spent getting to know one another and form group opinions and goals is essential to building a powerful voice and an effective union.
How Do You Engage in the Conversation?
Union Meetings – Most MNA union officers/Staff RNs meet monthly. Some meet quarterly. Attending union meetings is the best way to interact. You can join the discussion taking place, bring a newly recognized issue to everyone’s attention, or get the latest updates on what the union is working on or has planned for the future.
Professional Conference Committee/Labor Management Committee (PCC /LMC) are monthly meetings made up of half union nurses and half management/administration. PCC works on problem-solving and collaborative projects and can be an exciting place to move new ideas into new practices. Union contracts establish a specific number of voting members but guests are usually welcome to sit in and watch it happen. With advance notice, guests can often participate in the conversation as well, and if there’s a vacancy in voting members you may be able to become an assigned member.
Social Media Pages and Groups – Many of the MNA Local Units have social media sites where members can engage in discussions, share news, and coordinate meetings and other activities. On the state level, MNA also has a Facebook page and interacts with members on posts and through their messaging service. It’s where people engage these days, and your nurse union is no different.
Other means of engaging include emails and group emails, text messaging and group texting, publications like The Pulse, events like our annual Convention, and so much more. Our power is in our collective strength to move issues, to face challenges, and to make the world a better place for Registered Nurses, the families they love and support, and the patients for which they care.
If you’re not a part of the conversations taking place, your views are missing from our goals. I encourage you to look for the MNA communication path you will choose to build something powerful today!
Labor Reports and News
As contract negotiations occur throughout the year, Local unit bargaining teams and MNA Labor staff begin preparations for negotiations. One of our favorite tools is a Pre-Bargaining Survey which allows EVERY nurse to provide valuable input into the direction of your bargaining teams. They provide information by departments, on important economic items, staffing, general working conditions, and more! The information gathered is used to assist and direct your bargaining team while in negotiations.
How do we create the survey? A Pre-Bargaining survey is created out of pre-bargaining discussions with a local unit. As your labor representative begins bargaining discussions, they listen for the issues the nurses raise and create survey questions that allow us to gather more detailed information on how the majority of the local feels is the best direction to take at negotiations. Additionally, we review the contract and create questions that give the nurses the ability to rate what is most important and always offer an area that allows for open comments. The most important
Use your VOICE! Take your Local Pre-Bargaining Survey!
part of creating a survey is input from the nurses. We encourage every nurse to participate in the creation, drafting, and participation of the survey. Additionally, peer-to-peer discussions are the best way to encourage your co-workers to participate.
Why is a pre-bargaining survey important? There are many benefits to a pre-bargaining survey. First, as mentioned above, it allows for your bargaining teams and labor staff to gather a more complete picture of the direction the local unit wants to take at their negotiations and again, allow every nurse the opportunity to provide input. Any opportunity your labor representatives and negotiating team can speak phrases such as: “all the nurses feel…” or “90% percent of the nurses want …” it helps your team make a better argument at the table. We cannot underscore the importance of each nurse taking a few minutes to participate in their survey. A low survey participation rate reduces the effectiveness of the survey at the table.
When your local unit has upcoming negotiations, remember the importance of the Pre-Bargaining Survey! Ask your labor representative to help your local develop the survey and encourage all the nurses to participate! Participation is crucial towards the effectiveness!
Robin Haux, BSLabor Program
Director
Camping. Road trips. Days at the lake. It is a beautiful time of year in Montana and most people want to spend every second enjoying it. I am so thankful to live in this amazing state, but the beauty and lure of the mountains can make it difficult to engage our members during this season.
I have complied a few of my thoughts on how to continue to engage your members during this busy season.
1. Organize around major issues: Don’t just have a meeting to have a meeting. Utilize everyone’s time wisely by having a topic, issue, or plan to base your meeting on. Develop an agenda to keep the meeting on track. Make sure you are asking your members to show up for important meetings, not meeting just for the heck of it.
2. Meet them where they are: 10 minute meetings allow for quick updates before and after shifts. If your goal is to educate and update your members on a topic, the 10 minute meeting is golden. Reserve a meeting space in your facility (if possible), and hold your meetings before and after shift change or during breaks. Develop a short, focused agenda and stick to your timeframe. This is a great way to get information out there and log some face time with your members.
3. Make it accessible: Utilizing social media, not only to publicize your meetings but also to post
updates and inform your members is a fast and effective way to broadcast information. Facebook live is a great tool to utilize video updates on the happenings in your local or even hold digital 10 minute meetings. It allows for your union members to join meetings from anywhere and watch recordings anytime.
4. Fun Family Events: Having local celebrations or meetings that welcome kids and families to join will make it easier for many members to attend. Extra Credit if you hold your meetings at a local park or lake to make it a true summer event! I think pot-luck barbeques are a fantastic, cost effective way to bring your union members together for a fun afternoon or evening.
5. Respect their time: If you have difficulty rallying the troops during this season, don’t lose heart. We all need time away, time with our families, and time to ourselves. Time away can be rejuvenating and help to fire your members up for future meetings, collective actions, and working in solidarity to improve your working conditions. Encourage your members to take the time that they need, so they can come back stronger and ready for whatever comes next.
So with that, I encourage you to plan wisely. Have a
fantastic summer and stay safe out there!
Isn’t summer just the best??
Leslie Shepherd, BSN, RN, Labor Representative
BUILD SOMETHING POWERFUL TODAY
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Page 4 Montana Nurses Association Pulse August, September, October 2019
Labor Reports and NewsAFL-CIO Montana Annual
63rd Convention 2019MNA collective bargaining
members, rest assured you were represented by two wonderful candidates this year – staff nurses Jessica Sneddon from Missoula and Jennifer Miller from Glendive! MNA collective bargaining nurses please remember, the AFL-CIO convention is a very valuable event and being an MNA delegate is a fun and rewarding position, please consider this position in future!
Your delegates were well prepared and fully participated. They even volunteered to attend the resolutions committee even though that was not their assignment (though they were invited to attend without vote).
Elections for Officers took place, Al Ekblad was re-elected to the highest MT AFL-CIO staff position of Executive Secretary. Quint Nyman from Montana Federation of Public Employees was also re-elected to the position of Treasurer, MT AFL-CIO.
Randy Tocci, Local President for Local D-239 and a lead warehouseman in the Three Forks Emeris Talc Plant was elected President of the Montana AFL-CIO. As many of you know, Randy’s unit was locked-out of the Emeris Three Forks site for several months last year after contract negotiations broke down. MNA and
Amy Hauschild, BSN, RN, Labor Representative
MNA members wholly supported our Local D-239 union brothers and sisters by assisting them on the picket line, providing supplies and basically helping with anything they needed.
Kim Rickard, Laborers 1686, received the 2019 AFL-CIO Lifetime Achievement Award. Kim is the Business Manager for the Laborers 1686 out of Helena. Kim has worked tirelessly throughout her career supporting union workers in Montana.
The delegates to the 63rd convention passed several resolutions. I am going to iterate them by title, if anyone would like more detailed information, please do not hesitate to contact me directly and I will gladly provide more detail than this article space will allow!
• Resolution Supporting Worker Safety• Resolution Supporting Full Employment and
$15.00/Hr. Minimum Wage• Resolution Supporting the Protection of the
Right to Organize Act (PRO Act)• Resolution MT AFL-CIO Support for Public
Schools and Opposition to Privatization with Public Funds
• Resolution Opposing Plans to Close Job Corps Civilian Conservation Centers
• Resolution Opposing a Statewide Sales Tax• Resolution Opposing the Privatization of
Worker’s Compensation• Resolution Recognizing Climate Change,
Energy and Union Jobs
As nurses, we are on the front lines of patient care in Montana. Whether in Acute Care, Critical Access, or state facilities, we are in the best position to know what our patients and their families need to recover and stay well. At the MNA, as the voice for professional nurses across the state, we recognize that advocating for our patients doesn't just happen when it is time to negotiate a contract, but every single day.
Year after year, we are voted as the most trusted profession in America. When we speak, the community listens. It is our responsibility to make sure that we are speaking up when our patients are not getting the kind of resources they need. If you work in a facility with a collective bargaining agreement, you already have contract language and a process through which you can advocate for those kinds of resources. That may be through Labor-Management meetings or unit meetings. It may just be through working with the rest of the nurses on your unit to document and inform your hospital or clinic administration of shortcomings.
Many nurses across the state do not currently have a collective bargaining agreement, a contract. However, because Montana is a just-cause employment state, that means you have the professional protection to speak up for your patients and your coworkers. More often than not, our patients do not know if they are getting the proper and appropriate level of care. It is our responsibility to advocate for them when they cannot advocate for themselves. Trust in your expertise, your training, and your experience. You are the best chance your patient has to heal and stay healed.
Speak with your coworkers, the nurses working beside you every day and night. Get together outside of work and talk about your vision for your floor or unit. Share your experiences and be a support to one another. Remember, when nurses speak up, the community listens. Together we are stronger than we know, and our hospitals and clinics cannot run without us.
If you have questions about how to mobilize your coworkers to improve patient care, or if you feel as though you are being singled out for raising concerns, reach out to MNA's labor staff today. As your staff, we are here to support the working nurses of Montana and to help you make your voice heard.
Patient Care and Mobilization
Myles AionLabor Staff
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Montana ranked number six. Reported in Becker’s Hospital Review link WalletHub.com, key issues impacting nursing employment includes the aging U.S. population, the student-loan crisis and concerns about the future of key health policy programs. Despite those challenges, however, aspiring nurses have much to look forward to when they become licensed. Nursing occupations are some of the most secure careers with the lowest unemployment rates in the nation. In fact, projected through 2026, the industry is expected to grow at more than double the rate of the average occupation.
WalletHub analysts compared the 50 states and the District of Columbia across two key dimensions: (1) opportunity and competition, and (2) work environment. Analysts evaluated those two dimensions using 21 metrics, including nurses’ average annual
Montana Ranks Among Best States for Nurses to Work
salary, monthly average starting salary and mandatory overtime restrictions.
Here are the best states to work as a nurse based on the analysis:
1. Oregon2. Minnesota3. Washington4. New Mexico5. Maine6. Montana7. Arizona8. Nevada9. New Hampshire10. Iowa
Access more information about the metrics used for the analysis is available at the website:
ht tps://wa l le thub.com/edu/best-states-for-nurses/4041/#methodology
August, September, October 2019 Montana Nurses Association Pulse Page 5
no legislative agenda and action, workplace support, practice protection, or professional development, just to name a few. Please take time to read this article as it has been retyped from thin onion paper with typos corrected with multiple bold types over the top of incorrect letters (no such thing as white out or erase ink in the 60’s).
MNA appreciates you, Mary Munger, very much.
Montana Nurses’ AssociationWheat Building, Suite 326Helena, Montana 59601
Membership – A Professional CommitmentIt is one thing to have been educated and licensed
as an R.N., another to be employed as an R.N., but the mark of a real professional is a love for and interest in, what is happening to that profession, and a commitment to help it. Without taking this third step,
without identification as a member of the professional nursing organization, many nurses are merely draining the good from the profession without adding their share to keep it strong and dynamic.
What exists today as professional nursing, good or bad, is here because other professionals wanted to make it better, yes, for themselves, but also for future generations. What happens to nursing in the future is dependent on action taken by nurses today through their professional organization.
The privilege of licensure as an R.N. is probably nursing’s most precious heritage. It is recognition by society that nurses have a special service to give. Licensure was obtained because nurses united in organization were able to convince the state legislature of the need. MNA is once again in legislation to strengthen the Nursing Practice Act by making licensure mandatory for practical nursing just as it now is for professional nursing.
The content of nursing education, while everchanging, is a result from the work of many
nursing leaders who pooled their experiences and ideas within organization and set standards for schools of nursing to follow. These standards are under study within nursing organization.
The functions performed by nurses in various settings have been identified and mastered by professionals again through organization. These functions and responsibilities are subject to constant study because of the increased demands for nursing service and new discoveries of medical science. Today’s R.N. needs to be able to take on many new and complex responsibilities. Good examples are the intensive care units and coronary care units in hospitals where the R.N. sits at the control of machines and is the barricade between the life and death of patients within. Her call to the physician and her action until he arrives, will decide the fate of the patient. Freeing nurses from tradition bound duties so that he or she can perform as this highly specialized specialist is one of the greatest challenges facing the profession. The professional organization tries to help nurses become aware of, and accept, changing concepts of practice through institutes, workshops, professional journals, etc., but desire to change depends on the motivation of the individual nurse.
Through research financed by nurses, it is known that nurses are motivated when they are paid adequately for their services and when they share in making decisions about employment matters and which affect nursing practice – another professional goal.
After twenty years of effort great progress is being made this past year in not only raising nursing salaries, but in recognition by many, including employers, of the right of nurses to have more to say about their working conditions. The key to success this past year has been the unity among nurses – their willingness to work together collectively to seek needed changes. Nurses are demanding and getting more equitable salaries and their ideas for improving nursing practice are also being heard. MNA is again in the state legislature seeking a law to protect R.N.’s and L.P.N.’s as they try to work collectively to improve employment practices.
There are some poor practitioners in nursing as in most professions. When nurses salaries really reflect the value of the service, reach a professional level, patients can only afford to pay for the highest quality of care – the best nurse possible is another goal of the professional organization.
The mechanics of most organizations are not very interesting, but they are the lifeline – the umbilical cord – between the nurse and the profession. Dramatic changes are taking place within the professional organization on itself to better meet the change of nurses and the profession.
These major continuing concerns of the profession make up the substance of district, state and national organizational meetings. The help of all R.N.’s is needed to study the issues and make decisions which will safeguard the future of the nursing profession. Membership in MNA is a sure way of helping! (Munger, n.d.)ReferencesJacobson, H. (2009, July 17). A Walk through Hel-
ena, c. 1969. Helena Independent Record. Retrieved from https://helenair.com/news/opinion/a-walk-through-helena-c/article_1b2a91f2-a817-580a-91b0-b8a05ae289f6.html
Munger, M. (n.d.). Membership: A professional commitment. Letter.
MNA was once again in the state legislature (2019), advocating to strengthen the practice of our registered nurses. A bill MNA was able to advocate for our Advanced Practice Registered Nurses was SB 94 and states: “When a provision of law or administrative rule requires a signature, certification, stamp, verification, affidavit, or endorsement by a physician, the requirement may be fulfilled by an advanced practice registered nurse practicing within the scope of the advance practice registered nurse's certification; provided, however, that nothing in this section shall be construed to expand the scope of practice of nurse practitioners.” This signature authority bill is for all the APRNs, not just those that are members. The bill is critical for access to care issues and became law upon the signature from the Governor.
This is just a prime example of the good work MNA does and the need for all RNs to recognize the impact MNA has on the profession and commit to helping that continue by becoming a member of their professional nurse association.
Executive Director Report continued from page 1
Great news, The 66th
Montana Legislative Session was a success:
Senate Bill 94: Global Signature Authority: MNA worked gathering consensus and Senator Terry Gauthier brought the bill forward. There was no opposition in the legislature and it passed unanimously. This bill helps to reduce barriers by granting NPs the authority to sign paperwork when the APRN has the ability within their scope to sign such paperwork. There are several laws that were just written in the past years that omitted APRNs from signing. Rather than try and find each and every law to get “APRN” added, MNA helped
APRN Corner
Keven ComerMN, APRN, FNP-BC
write and submit the bill that would allow APRNs to sign if their scope allowed. These include some hunting permits forms, school forms, etc.
House Bill 98: This act amended provisions relating to physical and mental health evaluations of peace officers. Prior to the amendment, the law allowed only physicians to complete the exam. The amended section 7-32-303 now allows APRNs to provide these exams for peace officers. It was signed into law by Governor Bullock on April 17th.
I would recommend if you see a state form saying “physician-only signature,” that you copy the law and attach (staple it) it to the form and send it into the agency. If you get any questions, pushback or denials from the agency please reach out to me immediately so I can seek to remedy. If you are unclear about when you can sign, please reach out as well. [email protected]
For more information on the Bills visit www.leg.mt.gov
Page 6 Montana Nurses Association Pulse August, September, October 2019
1. Amber Dean DNP, PMHNP-BC; certified in Psychiatric Mental Health and Family Nurse Practitioner
2. Margaret Frankino RN-BC; certified in Psychiatric-Mental Health Nursing
3. Holly Gumz RN-BC; certified in Medical-Surgical Nursing
4. Carissa Petty RN-BC; certified in Medical-Surgical Nursing
5. Rebecca Martin RN-BC; certified in Medical-Surgical Nursing
6. Ciarra White RN-BC; certified in Medical-Surgical Nursing
7. Jessie Cheff RN-BC-certified in Medical-Surgical Nursing
8. Jack Crocifisso RN-BC; certified in Medical-Surgical Nursing
9. Lisa Stricker RN-BC; certified in Pain Management Nursing
10. Kaylee Dugan RN-BC; certified in Medical-Surgical Nursing
TO THE FOLLOWING NURSES WHO HAVE TAKEN ADVANTAGE
OF THE SUCCESS PAYS OFFERING BY ANCC TO MNA MEMBERS!
Janice D. Hausauer, DNP, APRN, FNP-BC won the AANP 2019 State Award for Excellence in NP clinical practice at the June annual AANP
awards ceremony in Indianapolis IN. Janice holds faculty appointment at
MSU College of Nursing and an active MNA member.
&
New Member Benefit: MNA now offers certification through ANCC’s Success Pays® Program
> Reduced fee for MNA Members to obtain initial certification or recertify
> No cost if you don’t pass the exam; you can also take the exam a second time at no cost
> Pay only when you pass!> Identify your specialty practice area
How Success Pays® Works> Visit nursingworld.org/our-certifications/ to:
• Make sure you’re eligible to sit for the exam• Look at the test blueprint and test preparation materials• Make the decision to move forward
> Visit www.mtnurses.org and click on Success Pays® option to the left and sign up for the program!> MNA will contact you regarding how to get the benefit.
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Free to Nurses
August, September, October 2019 Montana Nurses Association Pulse Page 7
Hope Sukut, District 3 – Attending the ANA conference in Florida was a definite high point in my short nursing career. Having newly graduated last spring, I didn’t know what to expect from a nursing conference. The facility was fantastic, the weather in Orlando was sublime and the conference was informative and inspirational. I gained insight, reignited motivation and made new friends at the three-day event showcasing the latest trends and technology in nursing. Particularly helpful to me were the general sessions and a workshop highlighting teamwork between physicians and nurses. It’s encouraging to hear what other nurses have accomplished for themselves and their facilities when they are willing to take risks to implement new ideas and work hard to improve outcomes for patients. I am so thankful that MNA made the investment to send me to this conference. I will attend more conferences in the future because of this experience.
Holly Gumz, District 1 – Because of the Montana Nurse’s Association, I was one of 10 attendees at this year’s ANA Quality and Innovation Conference in Orlando, Florida. Participants were offered a multitude of educational opportunities that piqued the interests of bedside nurses, including clinical nurse leaders and administrators. As an RN with less than three years’ experience, my goal in attending this year was to learn about new technologies to enhance patient outcomes in rural healthcare environments, including unique strategies to attract and retain nursing staff, specifically new-graduate nurses.
This conference shed light on multiple driving forces influencing quality and innovation in healthcare. One factor permitting hospitals to meet core measures, allow for creativity in problem solving and achieve a high level of nurse satisfaction is when collaboration takes place between nurses, medical providers and administrators.
Collaboration amongst care providers reinforces nursing insight and experience by including their thoughts and ideas into the decision-making process. This affects many aspects of care: the policies guiding our practice, the diagnostic equipment used to assess the patient and our ability to build rapport at the bedside with patients and family. Applying these and other conference discussions to unique Montana healthcare environments has the potential to overcome retention challenges and improve patient outcomes.
Tristan Ulmer, District 4 – Thank you very much for the opportunity to attend the ANA Quality Conference in Florida. The conference was very motivating and encouraged us, as nurses, to grow and not just be ready and flexible to change, but to be the ones who lead the change in providing better healthcare. We have the ability to build up other nurses and create a more positive and cohesive work environment. The conference talked about the voice we have as a nurse, that our voice matters and that we can empower one another to use our voices, appropriately and professionally, to create more
nurse leaders. We need to guide new nurses to not just be good, but to be the best nurse they can be. Thank you again, I really appreciate the educational opportunity and needed the encouragement.
Randy Parker, District 1 – The girls at work asked me how I was picked to attend the ANA Quality and Innovation Conference in Orlando, FL. I simply stated, “I always look at my E-Mail from the MNA.” I read the email, filled out the questionnaire, and was chosen to attend this wonderful conference. The MNA booked the airfare and hotel for me
and several nurses across Montana. They even had us registered for the conference. How easy is that?
Now I could go on for days about all the different presentations but I am not allowed so many words.
“Be The Spark” with Simon T. Bailey
Simon will get a crowd fired up and excited to be part of the experience. He spoke about failure and success. Did you know that failure comes before success in the dictionary? Are you willing to admit your failures so that others may learn? Do we admit our failures to ourselves and realize it is not the end, but an opportunity to improve ourselves? When is the last time you looked at yourself and did any sort of evaluation? Better yet, are you willing to ask people close to you “What do I need to work on”? We may not like the answers we are given but are we willing to listen and improve ourselves so that we may better serve others?
“Patient as CEO” by Robin FarmanfarmaianRobin spoke about the shifts in healthcare
and how to diagnose, treatment and access to direct patient care is changing and needs to make changes in this world we live in. Now there will always be a need for Emergency rooms and family doctors, but what if people started being the CEO of their healthcare? Robin has dealt with major health issues since she was in her twenties but no doctor once said: “Robin with the rapid advances in health care let’s hold off doing surgery and wait on technology.” If they would have held out for advances in medicine she may still have three major organs. In Montana, we lack the resources that the bigger cities have when it comes to just ordering up a nurse or other specialties to come to the home. I have to agree with Robin in the sense that most of us do not think outside the box when it comes to healthcare and how we can take more control over where or how we are treated for medical conditions. The average patient rarely questions their doctor on recommended treatments or gets a second opinion. Robin is asking for people to take control of their lives and not just settle for one person's opinion that may affect the rest of your life.
I want to thank Vicky and everyone at the MNA who helped me get to this conference. It was a blast and I look forward to sharing everything I learned with my co-workers!!
ANA Quality & Innovation Conference
• Full-time Mental Health and Management Faculty or
• Part-time Mental Health and Management Faculty and
• Clinical Resource Registered Nurses to oversee students in clinical sites.
JOIN OUR NURSING FACULTY
Contact me for more information: Susan Floyd, Director of Nursing, MSU – Billings City [email protected] | (406) 247-3073
City College at MSU Billings seeks:
Page 8 Montana Nurses Association Pulse August, September, October 2019
Professional Development DepartmentWhat’s next for nursing? Focus on 2020-2030
We are all familiar with the important work conducted by the Institute of Medicine (now the National Academy of Medicine), leading to the 2010 publication of The Future of Nursing: Leading Change, Advancing Health. This report detailed eight important requirements to position nursing as a key player in the healthcare system. These included:
1. Removing scope of practice barriers
2. Expanding opportunities for nurses to lead and diffuse collaborative improvement efforts
3. Implementing nurse residency programs
4. Increasing proportion of nurses with a baccalaureate degree to 80% by 2020
5. Doubling the number of nurses with a doctorate by 2020
6. Ensuring that nurses engage in life-long learning
7. Preparing and enabling nurses to lead changes to advance health
8. Building an infrastructure for the collection and analysis of interprofessional healthcare workforce data
A subsequent report published in 2015 provided a five-year update on progress in addressing these recommendations. Based on the work accomplished between 2010 and 2015, the IOM emphasized five key areas of focus for the next five years of the project:
1. Removing scope of practice barriers – while progress has been made in this area, there are still significant barriers to APRN practice. The new recommendation was to not only continue efforts to remove these barriers but
Pam A. Dickerson, PhD, RN-BC, FAAN
Director of Professional Development
also focus on interprofessional collaboration to improve healthcare practice.
2. Transforming education – significant work remains in the key areas of supporting academic advancement for nurses to obtain baccalaureate degrees; building sustainable nurse residency programs; encouraging advanced academic education, especially at the PhD level; and promoting life-long learning and interprofessional collaboration.
3. Collaborating and leading – nurses must be present and active in supporting change to promote health. The report encouraged nurses to engage in leadership positions in healthcare organizations as well as other health-promotion venues and to actively engage in interprofessional collaborative efforts and leadership development.
4. Promoting diversity – culturally sensitive care requires a culturally diverse workforce. The updated report recommended continued efforts to prioritize and promote diversity in nursing and other areas of health care.
5. Improving data – major gaps remain in analysis of healthcare providers, including types of providers, where they work, and the roles they fill. Data collection and analysis are important in identifying areas of need and prioritizing education and practice initiatives. Significantly more work is needed in this area.
Now – what about the future? Work is currently underway to analyze needs in the upcoming decade. A series of town hall meetings are being held to engage nurses around the country in considering:
1. The role of nurses in improving health
2. Current and future deployment across the healthcare continuum
3. System facilitators and barriers to diversity in the nursing and healthcare workforce
4. The role of nursing in facilitating engagement of individuals, families, and communities in shaping an evolving healthcare system
5. Training and competencies needed for nurses to practice outside of the acute care environment and be leaders in building a culture of health
6. The ability of nurses to serve as change agents in health care
7. Research needed to identify ways nursing can contribute to eliminating gaps and disparities in healthcare
8. The importance of nurse well-being and resilience
Montana State University professor Peter Buerhaus, PhD, RN, is a member of the Future of Nursing 2020-2030 committee. The committee is led by Mary Wakefield, PhD, RN, who is the former Acting Deputy Secretary of the US Department of Health and Human Services.
What you can do:Join the Future of Nursing listserv: https://us11.
list-manage.com/subscribe?u=1dee17686e06c5e596766b1df&id=b8ba6f1aa1
Join a twitter conversation using #FutureofNursing2030
You can be part of the action in shaping nursing and healthcare in the future!
August, September, October 2019 Montana Nurses Association Pulse Page 9
On June 6th, 2018, the President signed into effect the VA MISSION ACT for covered veterans to receive necessary hospital care, medical services and extended care services from non-VA entities or providers in the community. This rule became effective June 6th, 2019.
Veterans have very unique needs related to their service experience; types of physical, mental, and emotional situations to which they were exposed; location of deployment; and many other factors. We know that rates of illness and suicide are very high among the veteran population. Their families have complex needs, as well.
What are the interfaces between the VA and civilian health care sectors? What factors impact benefits for veterans and their families? How can we be sensitive to their needs, respectful in our care, and diligent in ensuring safe and effective interventions? How can we work effectively within our health care teams to meet veterans’ needs?
On Thursday, November 7, 2019, MNA will offer our fourth annual conference, “Seamless Health Care for Our Veterans,” jointly provided with the VA Healthcare Center, Fort Harrison, the Montana Geriatric Education Center, and the Montana Primary Care Association. This conference offers a unique opportunity for nurses and other members of the healthcare team to learn information, identify resources, discover tools to help civilian and VA healthcare providers meet the needs of this very special patient population, and network with colleagues from around the state.
It’s become common practice to ask patients, “Have you ever served in the military?” But what do you do with the answer to that question? Another question to ask a veteran is “What is the one thing you would want your doctor, nurse, therapist, employer, etc. to know about you as a veteran?”
How does the answer influence your care plan and future interactions with that individual and significant others?
There is a plethora of Military Culture information provided by the Bureau of Veterans Affairs. One resource I found was the PsychArmor Institute (https://psycharmor.org) which provides critical resources to Americans so they can effectively engage with and support military service members, Veterans and their families across our nation.
It listed 15 Things that Veterans want YOU to know: I found the following fascinating:
1. We are not all soldiers2. Reserves are part of the military3. Not everyone in the military is infantry (in tanks, on patrol, etc.)4. Military has leaders at every level in the chain of command5. Military is always on duty6. Take pride in appearance and conduct7. We did not all kill someone8. We do not all have PTSD
Professional Development Department
9. Those of us who do have invisible wounds of war are not dangerous or violent
10. It’s hard to ask for help11. Our military service changes us12. We differ in how much we identify with the military after we leave active
duty13. Our families serve with us14. We would die for each other and our country15. We all made this sacrifice for one reason: to serve something more
important than ourselves
Each year, conference topics are selected based on identified needs of providers and patients. This year’s conference will include sessions on Managing Pain in Addiction and Medication Assisted Recovery, Traumatic Brain Injury diagnosis and management and cognitive behavior therapy for PTSD, management of Insomnia and case management in assisting veterans and soldiers in accessing veterans’ benefits and care.
The conference will be held at the Education Center in the Lower Commons at Carroll College in Helena on Thursday, November 7th, 2019. We are also video broadcasting to host sites around this big state to bring this wonderful event to all interested healthcare providers. Healthcare professionals will register on the CNEbyMNA Website and may attend remotely in Lewistown, Glasgow, Miles City and Missoula. Details will be posted on the website also. All healthcare professionals are invited to attend! Please consider this resource for you and your colleagues. To register and view the agenda, go to our website at www.cnebymna.
How Do You Prepare to Work with Veterans?
www.cnebymna.com
Be sure to check out our CNEbyMNA Website for
Continuing Education opportunities. Sign up
for upcoming events and online learning courses. It is constantly updated with new
Webinars and Courses for your continued learning!
*Montana Nurses Association is accredited
with distinction as a provider of continuing nursing
education by the American Nurses Credentialing
Center’s Commission on Accreditation*
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$15.00 $15.00
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Performing a Quick and Helpful Physical Assessment
What is Your Learning Environment?
Transitions of Care:Interfacility Transfers
Quick Review of 12-lead ECG
Mary Thomas, BA, RNRN Professional
Development Associate
Page 10 Montana Nurses Association Pulse August, September, October 2019
Montana Nurses Association Approved Providers
Acute Care EducationVancouver, WA
Montana Geriatric Education Center of UMMissoula, MT With Distinction
Alaska Division of Public HealthAnchorage, AK
Montana Health NetworkMiles City, MT
Alaska Native Tribal Health Consortium Anchorage, AK
Montana VA Health Care SystemHelena, MT With Distinction
Alaska Nurses AssociationAnchorage, AK
Mountain Pacific Quality HealthHelena, MT
Alaska Regional HospitalAnchorage, AK
North Valley Hospital Whitefish, MT With Distinction
Alzheimer’s Resource of AlaskaAnchorage, AK
Pacific Lutheran UniversityTacoma, WA
Bartlett Regional HospitalJuneau, AK With Distinction
Partnership Health CenterMissoula, MT
Benefis Healthcare SystemsGreat Falls, MT With Distinction
Planned Parenthood of the Great Northwest and the Hawaiian IslandsSeattle, WA
Billings ClinicBillings, MT
Providence Alaska Learning Institute Anchorage, AK
Bozeman Deaconess HospitalBozeman, MT
Providence HealthcareSpokane, WA
Cardea ServicesSeattle, WA
Providence St. Patrick HospitalMissoula, MT With Distinction
Caring for Hawai’i NeonatesHonolulu, HI
South Dakota Nurses Association Pierre, SD
Central Peninsula General Hospital Soldatna, AK With Distinction
South Peninsula Hospital Homer, AK
Cheyenne Regional Medical CenterCheyenne, WY
St. Alphonsus Health SystemBoise, ID
Community Medical Center Missoula, MT
St. James Healthcare Butte, MT
Evergreen HealthKirkland, WA
St. Luke’s Health System Boise, ID
Fairbanks Memorial Hospital Fairbanks, AK
St. Peter’s Health Helena, MT
Kadlec Regional Medical CenterRichland, WA
St. Vincent Healthcare Billings, MT
Kalispell Regional Healthcare System Kalispell, MT
UF Health Shands Hospital Gainesville, FL
Kootenai HealthCoeur d’Alene, ID
Wisconsin Nurses Association Madison, WI With Distinction
Mat-Su Regional Medical Center Palmer, AK
Wrangell Medical Center Wrangell, AK With Distinction
MNA thanks all of the Approved Provider Units we work with for their commitment to advancing and promoting quality nursing practice through continuing nursing education.
Excerpts from ANA
August, September, October 2019 Montana Nurses Association Pulse Page 11
Tracey Long, PhD, RN, MS, MSN, CDE, CNE, CHUC, CCRN
“I hate my body.” “Where did all these ugly gray hairs and wrinkles come from?” “How could anyone find me attractive when I look like this?” “My body is such a burden.”
If you’re like 97% of the American population, you’ve probably said something like this to yourself. According to a repeat survey done by Glamour magazine 30 years ago and updated in 2014, 54% of women are unhappy with their body and 80% claim the mirror makes them feel bad about themselves. Even men admit to body image angst; from 1997 to 2001, the number of men who had cosmetic surgery increased 256%. Unhappiness about body image has been reported among girls as young as age six. Clearly, we need to evaluate the messages the mirror is sending to us.
Mirror, mirror, on the wallAlthough many of us rely on mirror messages
as the absolute truth, we need to be aware of the inherent distortions the mirror may hold. Ever since 8,000 B.C., when the mirror made its first appearance, people have been evaluating their personal worth based on their physical appearance. Two opposite attitudes exist: Some people are fixated by their own faces, as shown by an obsession with “selfies.” Others declare their body hatred throughout the day as we often see on social media. We have a love-hate relationship with the mirror—but the mirror may not always tell the truth.
People with anorexia nervosa see a distorted view in the mirror; some view themselves as fat even though they’re dangerously thin. The mere act of focusing on something, such as a nose or a mole, may make it look larger in the mirror. Even your mood may affect the way you see yourself. When you’re tired, angry, or anxious, the mirror may reflect your emotions more than your true physical image.
What the mirror tells youRelying on the mirror to tell you “who is the
fairest of them all” may not give you the whole truth. Despite potentially negative messages people get from the mirror, it can provide helpful information. It can tell you a lot about both the outside and the inside of your body. Although we focus on our exterior image, the mirror can provide information about the internal health of your body.
Using your nursing assessment skills, take an objective look at your skin and hair. The skin, the body’s largest organ, can provide a lot of feedback on your sleep (or lack thereof) and nutrition. Without adequate vitamin intake or sun, your skin may be pale and flaccid; without adequate essential fatty acids, it may be dull or dry. Stress, overwork, and lack of purpose in your life may reflect in the empty eyes that stare back at you.
What the mirror doesn’t tell youShakespeare’s Hamlet exclaimed, “What a
piece of work is man! How noble in reason, how infinite in faculty! In form and moving how express and admirable! In action how like an angel! In apprehension how like a god!”
The mirror doesn’t tell you about the amazing functions of your body systems, or that you and your body are the most brilliant creations in the universe. For instance, your endocrine system is an amazing creation of numerous autonomic functions working through feedback loops of chemicals to regulate many systems. It also balances your energy levels through the thyroid gland. When is the last time you thanked your adrenal glands for helping regulate your blood pressure via cortisol and aldosterone?
Thanks to auto-regulation, your body can maintain its temperature within the same general range even when the environment around it changes constantly. Breathing is controlled by tissues in your carotid arteries that track carbon dioxide (CO2) concentration and send messages to the brain’s respiratory center. Your body breathes faster or slower to eliminate CO2 as needed, all without your conscious awareness.
Your pancreas produces both insulin and glucagon, which naturally oppose each other,
but work in harmony to balance blood glucose levels. These levels affect the function of all three trillion cells in your body. Your glucose level rises in the morning to awaken you and give your cells energy to start the day automatically. Somatostatin regulates the endocrine system, balancing insulin and glucagon to work in complete balance without your attention. When is the last time you thanked your pancreas?
The mirror also doesn’t tell you how well your liver detoxifies drugs and chemicals and maintains your blood glucose level when you’re asleep. Nor does it reveal that your immune system constantly monitors and patrols your blood for foreign pathogens, which it then kills through a complex chemical cascade. Does the mirror tell you that your spleen has been working hard to store white blood cells and recycle red blood cells? When did you last thank your spleen?
What the mirror doesn’t tell you about your magnificent self is far more interesting and exciting than the cellulite you may glimpse in the mirror. It doesn’t let on that your body has innate abilities, such as auto-regulation, self-defense, and self-healing. Your body has the ability to detect injury and immediately goes into repair. Your natural self-healing includes the inflammatory process and movement of white blood cells to the site of damage to destroy pathogens that may have caused or entered the injury. Your body moves gracefully through tissue repair and healing autonomically, usually. We often treat our bodies so poorly and then expect them to perform without our support. An example is giving our bodies Styrofoam (such as poor food choices) and expecting it to repair like steel.
The nursing reflectionIronically, some nurses who care for sick patients
and help promote health and healing are unhealthy themselves. Research shows that occupational stress, poor coping behaviors, and lack of support create anxiety and depression in nurses. The longitudinal Nurses’ Health Study, which began in 1988, examines relationships among hormone replacement therapy, diet, exercise, and other lifestyle practices and chronic illnesses. It found female nurses’ health was no better than that of the general populace. Ideally, a nurse’s health should reflect their education and knowledge of the human body. Unfortunately, knowledge alone doesn’t create vibrant health. We should sing along with the Disney character Mulan, who asks, “When will my reflection show who I truly am?”
You’re invited to join the American Nurses Association campaign for action improving nurses’ health and wellness. For more information please visit http://www.healthynursehealthynation.org/ and view the free webinar on the grand health challenge for nurses at https://campaignforaction.org/webinar/improving-nurses-health-wellness/
As nurses, we can do better to reflect the true inner beauty of our bodies—and project that beauty in our lifestyles. Balancing the mirror’s messages is the key. What the mirror doesn’t tell you can inspire you to honor your body. What it does tell you can motivate you to care for yourself, so you can better model healthy behaviors for patients.
Fixng the mirror’s reflectionIn our society of quick fixes and limited
warranties, it’s easy—and often necessary—to replace just about everything. Most material objects can be replaced when they’re worn out.
The only thing that can’t be replaced is the human body. We can misuse and abuse it or treat it with loving care. Despite the amazing advances of medical science (and plastic surgery), your body is still your physical essence. Although it comes with a lifetime warranty, its quality isn’t guaranteed; that’s up to you. Our decisions can determine our destiny with health. Saying you don’t have time for your health today may leave you with no health for your tomorrow.
What does your mirror say to you? Will you listen?
AUTHOR BIOTracey Long is a Professor of nursing in Las
Vegas, Nevada for Chamberlain and Arizona College. As an identical twin, she regards her twin sister as her better reflection.
Selected referencesCoditz GA, Manson JE, Hankinson SE. The Nurses’ Health
Study: 20-year contribution to the understanding of health among women. J Women Health. 2009;6(1):49-62.
Dove® Campaign for Real Beauty. www.dove.us/Social-Mission/campaign-for-real-beauty.aspx
Enoch JM. History of mirrors dating back 8000 years. Optom Vis Sci. 2006;83(10):775-781.
Mark G, Smith AP. Occupational stress, job characteristics, coping, and the mental health of nurses. Br J Health Psychol. 2012;17(3):505-21.
Cleveland Clinic. Fostering a better self-image. Retrieve from http://my.clevelandclinic.org/health/healthy_living/hic_Stress_Management_and_Emotional_Health/hic_Fostering_a_Posi-tive_Self-Image
American Nurses Association health nurses campaign. Re-trieved from http://www.nursingworld.org/healthynurse
Song, M. and Iovannucci, E. Nurses Health Study. JAMA Retrieved from http://oncology.jamanetwork.com/article.aspx?doi=10.1001/jamaoncol.2016.0843
What the Mirror Doesn’t Tell You
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Page 12 Montana Nurses Association Pulse August, September, October 2019
Statewide Nursing News
Recently Dr. Zubin Damania (a.k.a. ZDOGG, MD) put a video online that was quite serious.
Over Nurses Week, I had a chance to not only view it but to share it with audiences that I presented for in Montana. These audiences were fellow healthcare professionals, mostly RNs, that could completely and strongly empathize with ZDOGG’s frustrations.
Now, if you don’t know who ZDOGG is, I would recommend you stop reading this and go search his name on the web. The guy is a RIOT. He is funny, intelligent and thoughtful. Most of his videos are rap song parodies about the day to day life of those in healthcare. But if you want to see ZDOGG’s more serious side,
search for his name and the term “moral injury.” You will see a video about six minutes in length that lays out the current litany of frustrations and shortcomings of modern healthcare workers.
ZDOGG suggests that we do not suffer from burnout but that we instead suffer from moral injury – the idea that we are harmed because we WANT to give the best care but that we are PREVENTED from doing so by a system that is calculating and non-empathetic about the plight of its patients and its care providers. ZDOGG goes on to suggest that we demand that our leaders lead and that we stop calling what we are experiencing “burn out” but rather call it “moral injury” because we are consistently injured morally when we have to decide between serving our employer or serving our patients. It is intense subject matter, especially when he mentions that suicide rates for physicians and nurses are higher than the general public.
Frankly, I couldn’t agree more.
Joey Traywick, CMSRN,
BS Kinesiology
Moral Injury VS Moral Authority
Climate ChangeClimate is affecting
our health. Today. Here in Montana. Montana Health Professionals for a Healthy Climate recently formed to promote the health of Montanans by helping address climate change through education, science, and advocacy. Our first official action was to endorse the Climate, Health and Equity Policy Agenda, released earlier this week.
The Climate, Health and Equity Policy Agenda, endorsed by 74 organizations representing more than half a million doctors, nurses, health systems, public health professionals, and patients, calls for urgent action and provides a roadmap for local, state and national leaders to act now to stop climate pollution, promote resilient communities,
and support the health of all Americans. Health Care without Harm, representing 17,000 hospitals, the American Medical Association, the American Academy of Family Physicians, and the American Lung Association are among the dozens of organizations signed onto the policy priorities.
The past several years has seen a surge of concern from the health community regarding lives lost due to the warming climate and the air pollution that causes it. But rather than just conveying gloom and doom, the health organizations’ Call to Action views climate change as the ‘greatest ‘public health opportunity of the 21st century.’ Many actions can both improve human health and reduce climate change. This report challenges the U.S. to embrace such steps. Effective changes in transportation, housing, land use, energy, agriculture, and other sectors are available, affordable, and potentially life-saving.
The Call to Action identifies ten recommendations from the health care community.
For example, using public transportation where available or bicycling/walking for short errands lends significant health benefits and lessens greenhouse gas emissions that help heat up our planet. The promotion of farmers markets boosts the purchase of local products, improves the sense of community important to mental health, and lowers emissions from transportation. Transitioning to renewable energy saves lives by decreasing air pollution and lowers greenhouse gas emissions. Similar actions are already occurring, but health providers say the pace of transformation needs to be quicker.
Equity is ‘central to climate action.’ As with many health conditions, climate hurts certain populations more: children, the unborn, pregnant women, the elderly, indigenous peoples, low-income people, outdoor workers, and those with chronic diseases. All these populations are well-represented in Montana. Physicians and other healthcare professionals feel a moral responsibility to safeguard the vulnerable and contend that U.S. climate policies and investments can serve to alleviate current injustices.
Like the majority of Americans, the health community advocates for meeting and strengthening the commitments made by the United States in the Paris Climate Accords. Doctors, nurses, and other healthcare professionals want to optimize health for their patients and other members of their communities. Climate Change represents a threat to the substantial improvements in public health of the last century. We must minimize the threat and promote the opportunities.
Julia RyderBSN, RN, CEN
Recent revelations in healthcare have ROCKED our ability as healthcare workers to say that we represent the moral high ground. From pharmaceutical companies found guilty of hiring exotic dancers to influence physicians to write prescriptions for Fentanyl to sexual harassment claims at the highest levels of leadership here at home, we are desperate for an answer as to WHY keep doing this line of work? Long hours, sacrificed personal lives and an increased sense of helplessness underline what ZDOGG described as moral injury. And I believe he is spot on.
Yet, there is still something I read recently from Mother Theresa that helped me put things in perspective. You and I signed up for this work precisely BECAUSE of moral injury. And physical injury. And spiritual injury. We are healers of injury. In spite of the lack of moral integrity at the upper echelons, we heal anyway. Don’t give up. ZDOGG may be right but his call to action is lacking. He simply asks that we get mad, demand more from our leaders and share the video.
Stacy Luke, MAPP-Net Program Specialist
In September 2018, the State of Montana received a federal grant from the Health Resources and Services Administration in to expand access to pediatric psychiatry. The Montana Access to Pediatric Psychiatry Network (MAPP-Net) grant strives to support primary care providers serving children and youth in their communities with mental healthcare needs through education and consultation.
Project ECHO, a hub-and-spoke model out of the University of New Mexico, began in March 2019. An expert Hub team consisting of a Child and Adolescent Psychiatrist, Psychiatric Pharmacist, and Psychotherapist meet twice per month with primary care providers across the state utilizing the online platform Zoom. A member of the Hub team delivers a 15-20 minute didactic. Then, any participating primary care provider can present a de-identified case to receive recommendations from their peers across the state and the Hub team. Primary care providers wishing to participate can enroll on the Billings Clinic Project ECHO website. There is no cost to participate.
A toll-free access line will be established in Fall 2019 for primary care providers to call and consult with a Child and Adolescent Psychiatrist during daytime business hours. Billings Clinic is contracted with the state to staff this phone line, so consultations will be with Montana-based Child and Adolescent Psychiatrists. This is a provider to provider call, and patients do not participate. More information about this line will be disseminated as it becomes available. There will be no cost for primary care providers to participate in this service.
If you are interested in receiving additional information about the services available to primary care providers through the grant, please contact Stacy Luke 406-444-3529 [email protected]. Stacy can schedule a visit to your clinic to meet with providers or add your name to the stakeholders list to receive updates, including the access line information when available.
Stacy LukeMAPP-Net Grant406-444-3529
Montana Access to Pediatric
Psychiatry Network
August, September, October 2019 Montana Nurses Association Pulse Page 13
This morning the news proclaimed the placement of nets on each side of the San Francisco bridge due to the many who try to commit suicide from jumping off the bridge. A middle-aged man told his story of being less than 20 years of age and jumping head first off the bridge and hitting the water head first. He did not die; however, had a fractured spine. He said that as soon as his foot left the railing he was “remorseful” for his attempted suicide actions. He declared that if only just one person had looked his way, said one word of kindness, smiled at him, or any such small thing of compassion, he would not have attempted suicide. He is an older person, now, who has spent his life helping others so that they will not feel that lack of caring by others, and maybe (just maybe), they will have the strength to continue their life in a more positive manner.
You probably are saying – “Oh, we do and encourage compassionate care!” My answer: Then, why are health care patrons/patients sometimes saying differently? Why do some patients recognize a lack of established compassionate protocols?
Professional nurses, have heard and personally experienced (in some situations) the lack of
how and why to practice overt compassion!
I have read a “thank you” from physicians who recognize that truly observable compassionate
behaviors most often come from nurses who have saved many a life and have inspired many a physician to be a better physician! That makes me proud!!
As you read the researched studies about compassion, ask yourself why we have not always recognized something so obvious and simple? Why has it too often taken too long to connect the dots? Have we been so caught up in the technical aspects of nursing as a nurse specialist or a nursing instructor that we (as specialists) downgrade (or at least not emphasized as much as we can) the very gift that can make, in many cases, the most significant difference? Clearly, it is not just what you say but what you are communicating non-verbally to other people!
Theodore Roosevelt said, “People don’t care how much you know until they know how much you care.”
WHAT DOES “BEING COMPASSIONATE” MEAN ACCORDING TO RESEARCH?
By definition, compassion is an emotional response to another’s pain and/or suffering — not just being kind or nice. This behavior is a true desire to be helpful to every patient. It involves feeling, understanding, and taking action, so much more than just empathy. Where empathy is a precursor to motivate action, compassion expressed by a person can be actually be witnessed in the brain of a person during a functional magnetic resonance imaging (fMRI). The fMRI shows an actual subtle difference in cerebral blood flow. Empathy will actually cause a lighting up of the brain centers, but with the act of compassion another area of the brain lights up related to alleviation of another person’s suffering and positive emotion. This is what it means to be “human” and the ability to look deeply into the compassionate meaning of things.
A professor at Harvard University told a story about a screaming baby on a flight where a small child was screaming at the top of his/her lungs. Now — we would expect some adult person on the flight to try to console this child — but, no! Sliding out of his seat and moving toward the screaming child was a three-year-old and with his own pacifier in hand. He toddled down the aisle and offered it to the screaming child. That very small child felt the need to respond and decided to do something about it! His action was the true meaning of compassion!
COMPASSION: CARING THAT TRULY MAKES A DIFFERENCETHE CURRENT STATUS OF THE ACT OF COMPASSION
Researched statistics show that nearly half of Americans believe that providers are not compassionate. It does not involve just the U.S., but it has been reported by the National Health Service Foundation (NHS). It requires an ability to make a connection with another person.
Have you ever been so tired from nursing others that you have personal emotional exhaustion, a feeling of no personal accomplishment, and depersonalization? It is a universal happening. If you combine physical tiredness with emotional exhaustion there seems to be no room for compassion! It is often called, burnout! In this situation, research has shown that healthcare professionals find it easier to relate to a cluster of symptoms rather than a whole human being. However, we (nurses) can do the following to promote our compassion:
1. Listen carefully and looking for the need for compassion. Research shows 60-70% of a patient’s need for compassion are missed or not recognized. A missed opportunity of compassion could change the trajectory of a person’s life.
2. Remember that nursing, as a professional discipline, has expectations of emotional involvement with patients.
3. Be an example and mentoring for nursing students and other nurses.
4. See the need – have time for the need – care about the need – know how to meet the need – understand that it really does matter!
5. Be willing and able to say to a patient and family that you (the nurse) recognize the tough experiences he/she/others are going through.
6. Be willing and able to say to a patient/family that you will be there for them each step of the way during their health crisis. Walk that lonely mile with them!
How Compassion Influences Physiological Health –
1. Loneliness is a subjectively perceived experience of isolation. It is the difference between one’s desire and the actual level of human interaction. Research of over 300,000 participants with different health conditions found that having meaningful relationships was related to 50% higher odds of survival. A high number of studies on the risk of loneliness found that there were 26 percent higher odds of early death, and 50 percent higher risk of functional status decline and cognitive function. Being alone was not the issue—it was being lonely.
2. Heart attack patients with no emotional support had three times higher odds of death in comparison to patients with emotional support. Literally speaking, it takes emotional support to help heal a broken heart.
3. University of California found that loneliness (which includes a lack of compassion-giving and compassion-receiving) affects the genes, which are involved in the immune response. It has been found that persistent turning on and turning off genes in the immune system can produce chronic total systemic inflammation connected with many negative health effects.
4. Takotsubo cardiomyopathy (broken heart syndrome) is caused by extreme emotional stress. This condition causes cardiac failure. Compassion helps mend the broken heart!
5. People with the least human connection (hence lack of overt compassion or lack of willingness to give compassion) were found to be more susceptible to the common cold. There was, also, a general lacking in human resistance to illness.
6. There is a parasympathetic nervous system activation. Where the sympathetic nervous system produces an increase in sympathetic and cortisol to produce the fight or flight stress
response, the parasympathetic nervous system lowers stress levels causing a warm and calming effect as a result of compassion.
7. There is a rise in oxytocin in the body during the giving and receiving of compassion which increases the feelings of a human connection, nurturing and bonding. This hormone is sometimes called “the trust hormone,” the “bonding hormone,” or the “love hormone.”
8. A compassionate touch can lower blood pressure.
9. Anesthesiologists have found that a pre-operative compassionate connection with a patient as part of the therapy results in a patient that is more likely to be peaceful and calm.
10. Nurses performing a specified compassion intervention preoperatively found that patients randomly assigned to compassionate interventions had 50 percent postoperative lower scores on pain ratings.
11. Trauma patients reported one year after a trauma they were four times more likely to have a good outcome from the trauma if the physician(s) showed high compassion in handling their care.
12. Patients receiving compassionate palliative care have a better quality of life and live longer—on an average of 30% longer.
13. The human connection of compassion can modulate the pain experience in many ways. Endogenous opioids produce endorphins, a naturally produced molecule in the body that provides an analgesic effect which reduces pain—and sometimes it presents as a euphoria.
14. Compassionate touch matters and has been shown to significantly decrease or completely eradicate the sensation of pain in another person. There is a “physiological coupling” of the cardiovascular and respiratory system during experimentally induced pain. The person performing the compassionate touch literally synchronizes with the person having the pain. Their autonomic nervous systems and brain waves actually align. During painful studies of unpredictable electrical shocks causing pain, just the mere holding hands of a trusted person resulted in the brain growing quiet.
15. Patients with metastatic breast cancer participating in supportive-expressive compassionate groups showed significantly reduced pain over time.
16. Building trust takes time. However, once trust and compassion are established between a health care provider and a patient, pain is significantly reduced.
Carolyn TaylorEd.D, MN, RN
Compassion: Caring That Truly Makes a Differencethe Current Status of the Act of Compassion
continued on page 14
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17. Physical therapy pain studies of two-hundred patients experiencing compassion enhancement in conjunction with therapy experienced pain relief more than doubled than without compassion enhancement. The study continued to show pain relief even six months later.
18. When the CARE measure (Consultation and Relational Empathy) survey instrument in compassion science research was used, there was a high correlation between decrease in migraine headaches and the degree of intensity of headache pain.
19. IBS (Irritable Bowel Syndrome) causes great suffering. Out of 262 patients with this condition, the group augmented with compassionate care had doubled the number of patients not receiving compassionate care in the control group.
20. Compassionate behaviors such as nodding, leaning forward, eye contact, smiling, aided in the physical and cognitive functioning of elderly patients. Conversely, the opposite of such behaviors were/are associated with decreased physical and cognitive functioning of the elderly patient.
21. Optimal blood control sugar levels were 80% higher with compassionate health care providers.
22. Patients having high compassion health care providers had 41% lower odds of serious diabetes complications.
23. A patient’s wounds heal faster with compassion. Time for a wound to heal was significantly shorter, specifically 17 percent shorter (e.g. five days instead of six days).
24. People with high stress levels and more conflict in their lives are more likely to develop cold symptoms – (evidenced by viral replication, antibodies to the cold virus, and symptoms). Social support and hugs in the 14 days of research protected against the viral infection.
25. Compassion is associated with the enhanced immune response, a one day decrease in the duration of cold symptoms, and 15 percent decrease in cold symptom severity.
26. Compassion can literally keep a patient breathing. It is not just any nurse that has this ability – it is a special nurse known to many as “their angels” – or shall we say nurses with compassion!
A direct quote from a recovering patient who thought he would never breathe again says this:
“After weeks of being on a ventilator in the ICU, I could tell right away when a new nurse came on duty at the change of shift and entered my room. I could tell within one minute whether or not the nurse cared. If it was a nurse who did not care, my heart would sink. My spirit was crushed. I lost my will, and I did not believe I would ever get off the ventilator. But if it was a nurse who cared, one of my ‘angels’ I would instantly feel stronger. I believed I could beat this and breathe on my own again. Without my angels, I never would have made it. Their compassion is what saved me.”
(Compassionomics by Stephen Trzeciak and Anthony Mazzarelli)
How Compassion Influences Psychological HealthResearch shows that one out of five people we meet have a mental health
struggle. You, as a nurse, can have an effect on someone’s psychological health. Showing compassion can decrease negative effects of all sorts of psychotic disorders, eating disorders, post-traumatic stress disorders, major depression, and the feelings/desires to commit suicide. Drug therapy can be very useful, but the human connection is very important and makes a difference.
1. Psychiatrist’s/Therapist’s/nurse’s efforts of compassion actually increased the effects of drug therapy. Therefore, the psychiatrist could be considered as a means of treatment (not just a provider of treatment.)
2. Out of the several categories considered by patients’ assessments of their therapists, the major positive factor in depressed patients was the compassionate connection with their therapist.
A therapist’s compassion has a moderate to large effect on reducing symptoms of depression.
3. With cancer patients, compassionate care builds patient self-efficacy, activation, and encourages active involvement and participation in his/her treatment.
4. Compassionate language is associated with adherence to antidepressant medication and even the trip to the pharmacy to acquire their medication.
5. A therapist’s distancing behavior of himself/herself in preparation of patient discharge from a health care facility/situation had a tendency to increase depression.
6. Compassion of nursing home aides was associated with lower depression in nursing home residents.
7. Compassion can alleviate anxiety.
8. In regard to Post Traumatic Distress Disorder (PTSD), if the caring interventions are applied at first recognition or during a trauma there is more likelihood that PTSD does not develop. Researchers found that compassion from others was very effective to prevent PTSD; however, it was found that self-compassion was most effective.
9. Child-life specialists have learned how to help a child through traumatic experiences. Tender care and compassion are the main methods of treating the child.
If the new compassionate on-going research hypothesis is true, it has the potential of changing worldwide emergency care. Now we know that compassion from health care providers can have a major impact on a patient’s hope for recovery.
Compassionate communication (not just communication) raises recovery expectations and is effective. How a patient believes they will do is a major factor in how they will do, even if they will survive. It makes the unbearable bearable. Learning to communicate compassionately is one of a nurse’s greatest gifts.
A specific direct quote from a breast cancer survivor as a result of a health care provider’s compassion said this:
“…and as I left his office, he said, ‘You know, you have a very bad disease, but we are going to take care of you.’ The doctor-patient relationship was incredibly therapeutic and reassuring. I had no qualms, no doubts with putting my life in his hands. I had full confidence in his expertise, his concern and emotional support.”
(Compassionomics by Stephen Trzeciak and Anthony Mazzarelli)
How Compassion Influences Patient Self-Care
1. One of the first activities a home-health nurse usually does is to determine compliance to a physician’s medication regime. Nonadherence to any physician-prescribed regimes is often the result of a patient’s belief that nobody cares. This can lead to loneliness and depression. However, if the home health nurse does care and shows compassion toward the patient, the patient is more likely to comply to medication and other prescribed health care regimes.
2. Compassion from nurse’s aides in nursing homes was associated with a reduction in learned helplessness among elderly nursing home residents.
3. Human Immunodeficiency Virus (HIV) patients had 33 percent higher odds of adherence to therapy when they knew their HIV patients “as a person.”
4. Cancer patients with high compassion providers had 13% to 30% higher rate of cancer screening compliance and health screening recommendation.
5. More positive communication (not negative communication) from health care providers encouraged adherence to health care regimes.
RECOMMENDED READINGCompassionomics, The Revolutionary Scientific Evidence that Caring Makes a
Difference by Stephen Trzeciak and Anthony Mazzarelli (forward by Senator Cory Booker) 2019
”More than Kindness” – Journal of Compassionate Health – July 13, 2015
Compassion: Caring That Truly Makes a Difference the Current Status of the Act of Compassion continued from page 13
NOTICECALL TO 2019 MNA ANNUAL CONVENTION
HOUSE OF DELEGATES
2019 Convention Proposed Amendments to the MNA BylawsPurpose: Align MNA bylaws with best practice standards related to
terminology in the following articles:
Striking the words, MEA-MFT and inserting the words MFPEArticle II Membership and Dues, Section 2. Qualifications (c.)Article II Membership and Dues, Section 3. DuesArticle II Membership and Dues, Section 5. Membership Rights (a.)Article II Membership and Dues, Section 5. Membership Rights (c.)Article IV Board of Directors, Section 7. Qualifications (a.)
Striking the words Executive Director and inserting the words Chief Executive Officer;
Article IV Board of Directors, Section 11. Executive DirectorArticle XV Relationship with the American Nurses Association, Section 2.
Representation (b.) 1.
Striking National Federation of Nurses (NFN) as it exists as an informal coalition;
Article X Council on Economic & General Welfare (E&GW), Section 7 Collective Bargaining Assembly (c.) 2 & 3
Update ANA Representatives to reflect current practice to 4 representatives with 2 elected every year with alternates
Article XIV Elections, Section 4.
Update AFL-CIO Delegates to be elected yearly with alternates to aid in support and participation
Article XIV Elections, Section 5.
Consider term adjustment to allow for continuity with board positions by Striking “more than two (2) consecutive terms in the same office or”:
Article IV Board of Directors, Section 6. Term of Office (b.)
Consider vacancy adjustment to help fill the HOD by inserting the words “from any district”
Article III House of Delegates-MNA, Section 3. Composition (d.)
August, September, October 2019 Montana Nurses Association Pulse Page 15
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