nursing news• osteoarthritis affects over 20 million people in the us, most over 40 years old. •...

• St. John’sWort is being tested on patients with mildtomoderatedepressionwithrelativesuccess.It isalsousedforSADandneuralgicpain.Adrawbackisahalflifeof25hoursandinteractionswithseveralcommonlyuseddrugsincludingwarfarin,digoxinandphenytoin.

• GinkgoBiloba increases blood flow to vascular areasandregulatesvasculartone.

—SteveOttariano,RPh

current resident or

Presort Standard

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PAIDPermit #14

Princeton, MN

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www.NHNurses.org

January 2009 Official Newsletter of New Hampshire Nurses Association Vol. 33 No. 1

NursiNg NewsQuarterly Circulation 25,000 to Registered Nurses, LPNs, LNAs, and Student Nurses in New Hampshire.

Over 160 nurses and nursing students learned from theexperts about new innovations in drug therapy and theirnursinginnovationsattheannualFallNHNAconference:“Rx for RNs—Keeping up with Pharmacology”.Participants chose from eight breakout sessionspresenting a range of new developments in drug therapyfrom palliative care to psychopharmacology. A host ofpharmaceutical (and other) exhibitorswere also on hand,sharinginformation.

Pharmacist Margaret Kerns from Lakes Regional spokeon the culture of change and links to patient safety inmedication administration. Nurse Practitioner DonnaPelletier presented the use of NSAIDs especially inpatients with osteoarthritis. Pharmacist Steve Ottarianofrom the VA Hospital in Manchester discussedsupplementaltherapiesincludingherbs.Nursepractitionerand cardiac expert Carmen Petrin reviewed new andold cardiac medications. Dr. Carolyn Crosby presentedpharmacologyofsymptommanagementinpalliativecare.Nurse Practitioner Wendy Wright provided an extensivereviewofimportantchangesinimmunizationsforchildrenand adults. Diabetes Educator Liz Kennett provided thecurrent information on insulin management while Dr.MichaelMcGeediscussednewadvancesinpharmacologyforpsychiatricillness.

SomePearlsfromNHNAFallPresenters:

• A safety climate is palpable when a safety culture isthe way of doing things. Climate develops from anorganizationalculture.Tochangetheclimateyoumustchangetheculture.

• Safety requires an informed, reporting, flexible andlearningculture.

• 60% of medication errors are derived fromcommunicationproblems.

• 90%oferrorsareblameless.• Risky behaviors can be traced to drifting, to drift is

human—wealldoitdependingonthecircumstances. —MargaretKerns,RPh

• Osteoarthritisaffectsover20millionpeopleintheUS,mostover40yearsold.

• Over33millionAmericansuseoverthecounterNSAIDs.

• The value of ibuprofen over aspirin includesmorespecificfocus,longerhalf-lifeandgreaterbenefitwithlessriskofsideeffects.

• 20% of patients with asthma will have ahypersensitivityresponsetoaspirin.

• Acetaminophenisappropriateforpainandfeverbutnotinflammation.

—DonnaPelletier,MS,APRN

• The science of using plants as medicinals isdescribedasphytotherapy.

Also in this issue:

Letter from the President—Louise Smith Cushing2

American Nurses Association News6 & 7

Center for American Nurses; Contest Winners7

NHNA Election Results 8

SAVE THESE DATES–2009 Events12-13

In Memoriam14

Health Reform—Time for Nurses to Tune In,Take On, & Turn Out17-18

New Hampshire Membership Application22

ExpErts Inform nursEs of InnovatIons In pharmacology

Experts Inform Nurses continued on page 3

ANA President, Becky Patton delivers keynote.

• New Hampshire Nursing News January, February, March 2009

NURSING NEWSVol.33No.1Official publication of the New Hampshire Nurses’Association (NHNA). Published quarterly. Librarysubscriptionrateis$24.ISSN0029-6538

Editorial OfficesNewHampshireNursesAssociation,210N.StateSt.,Concord, NH 03301-3595. Ph (603) 225-3783, FAX(603)228-6672,[email protected]

NHNA StaffAveryMorgan,ExecutiveDirectorAdvertisingFor information and rates on ads, please contact theArthurL.DavisPublishingAgency,Inc.,POBox216,CedarFalls,IA50613.Ph(800)626-4081,FAX(319)277-4055,E-mail [email protected]’AssociationandtheArthurL.DavisPublishingAgency,Inc.reservetherighttorejectadvertising.

NURSING NEWS is indexed in the CumulativeNursingIndextoNursingandAlliedHealthLiterature(CINAHL)andInternationalNursingIndex.

StatementofopinionistheresponsibilityoftheauthoraloneanddoesnotimplyanopiniononthepartoftheofficersorthemembershipofNHNA.

VISION STATEMENTTo be the premier resource for professional practice andadvocacyfornursesinNewHampshire.Adopted: 11/15/99

MISSION STATEMENTTheNewHampshireNurses’Association,asaconstituentmember of the American Nurses Association, exists topromote thepracticeofprofessionalnursing, advance thedevelopment of professional nurses, and improve healthstandards and availability of health care services for allpeopleofNewHampshire.Adopted: 10/16/97

PHILOSOPHYMembership and participation in the professionalorganization affords each nurse the opportunity tomakea unique and significant contribution to the professionof nursing. The membership of the New HampshireNurses’Association, individually and collectively, has anobligation to address issues related to the developmentand maintenance of high standards of nursing practice,educationandresearch.Weparticipateintheproceedingsof the American Nurses Association (ANA) and supportandpromoteANAStandardsanditsCodeofEthics.We believe that the profession of nursing is responsiblefor ensuring quality nursing practice and that continuingeducationinnursingisessentialtotheadvancementoftheprofessionandthepracticeofnursing.We believe that nurses function independently andcollaboratively with other professionals to enhance andpromote the health status of individuals, families andcommunities.Wehaveanobligation to initiate legislativestrategiestoimprovethequalityofhealthandthedeliveryof health care services while promoting quality practiceenvironments thatadvocate for theeconomicandgeneralwelfareofnurses.Adopted: 5/80Revised:1991Revised:12/4/97

lEttEr from thE prEsIdEnt

Our Year in 2008 and Moving Forward to 2009Louise Smith Cushing

We have certainly been busyhere and I look forward to aneven more productive year in2009. The Presidency has beena steep learning curve for meandIappreciate theopportunitytoserveforanotheryear,havinggained a clearer understandingof NHNA and the direction inwhichwewanttomove.

2008 gave me several memorable moments which Iwould like to sharewithyou.The first tookplace at ourNurses’ Week celebration, “Champagne and Scrubs.”Whilewelcomingeveryoneatthereception,Iwasstartledby a verywell-dressedwomanwho took themicrophonefromme to tell thecrowdaboutherexperienceswithherphysicianhusbandintheVietnamWar.LaterthateveningI found myself overwhelmed with pride as I welcomedover 250 nurses to view the Emmy Award winningdocumentary“VietnamNurseswithDanaDelaney”whichwas introduced by its creator,NewHampshire’s ownDr.MargaretCarson. I asked the audience to applaudnursespresentwhoservedinthearmedforces.Theresponsewasheartwarming.

In June, Iwaspart of theNHNAdelegation at theANAHouse of Delegates (HOD) in Washington, D.C. I wasmovedtotearsattheopeningceremonyoftheHODasourNationalAnthemwas played and I looked around to see600+delegatessodedicatedtothenursingprofession.

Myscariest experience thispastyear cameon theeveofourAnnualMeetingandFallConvention.IwastopickupANAPresident,BeckyPattonat theairport tospeakatalong-planned “Dinner and Dialogue” meeting with over40 nurse leaders from around the state–and then at theannualconvention thenextday.Enroute toManchester Ireceived thedreadedphonecall.Mechanical troublewiththe flight and amissed connectionmeant shewould notbearrivinguntilhoursafter thedinnermeeting. (Luckilyshewassafe!)Iwasinstructedtopreparetofillinfortheevent.Ugh! I called uponmyNHNABoardofDirectorscolleaguestoassistmeandtheeveningwentwell.

• Moving beyond personal reflection–what has NHNAaccomplished over the past year? We hosted threevery successful educational conferences and a specialnurses’weekeventwiththesupportoftheCommissiononOrganizationalAffairs.

• The Commission on Continuing Education continuesto work diligently in approving continuing educationprograms based on ANCC standards. They are alsoactive consultants for nurse educators who needassistancewiththisprocess.

• TheGovernmentAffairsCommissionandourlobbyistwere active in the 2008 legislative sessions and arecurrentlyworkingontheissueofsafestaffing.

• NHNA is also proposing a resolution supporting“Educational Advancement for Registered Nurses,”affirming the need for increased numbers of RNswith baccalaureate degrees and higher to address thechallengesofourcomplexhealthcaredeliverysystemandcriticalnursingfacultyshortage.

• The Commission on Nursing Practice (formerlyProfessionalAffairs)awardedascholarshipforanurseinterested in pursuing an advanced degree with theintentionofteachinginNHupongraduation.

• TheBylawsCommitteerevisedourbylawswhichwereapprovedbythemembershipinOctoberatourannualmeeting.Twomajorchangesweremadeinourelectedofficers; we now have a President-Elect rather than aVice-Presidentwith the intention that thispersonwillbe mentored by the President for one year and thenmove up to President. I strongly advocated for thischange.Secondly,wewillnowdesignateoneDirectoratLargepositionbefilledbyarecentgraduate(within5yearsofgraduation).Wealsochanged thenamesofthe two of the standing commissions to better reflecttheir roles in the organization. The purposes/goalswere revised to reflect our positiononworkplace andworkforceadvocacyversuscollectivebargaining.

The Board of Directors met in August for a strategicplanning session with facilitator,Margaret Franckhauser.The Board identified three priority areas: continuingeducation; membership and workplace advocacy–andspecificgoalsforeach.Wehavealreadymovedforwardonseveralidentifiedinitiatives:

• Wehave planned three conferences for 2009; anotherspecialeventtokickoffnurses’week(seecenterfoldofthisissue)andthreeCertificationReviewweekendsforeithermedsurgorcriticalcare.

• Wehavebeguntoengagemorenurseleaders/executivesin themission and vision ofNHNA–asking that theyhelppromotetheideaofprofessionalmembership.

• TheNHNABoard ofDirectors voted to become fullmembersoftheCenterforAmericanNurses(CAN)inSeptember, affirming our commitment to workforceand workplace advocacy. We feel this action willequip nurses at all levels of experience to be theirown best advocates in the workplace. The focusof CAN is the nursing workforce, recognizing the

Letter from the President continued on page 3

Visit us on the Web at

www.NHnurses.org

January, February, March 2009 New Hampshire Nursing News •

challenges nurses face today including: 1) improvingtheir practice environments; 2)meeting their personalandprofessionalgoals;and3)promotingexcellenceinpatient care. The Center for American Nurses offerstools, services, and strategies designed to help nursesmeet these challenges in their work environment.Full membership in ANA-NHNA, includes automaticmembership in CAN and access to all their servicesand publications. I invite you to visit their website:www.centerforamericannurses.orgtofindoutmore.

At the end of October, our Executive Director and Itraveled to Silver Springs, Maryland to attend the ANAConstituentAssembly.TheConstituentAssemblyconsistsof the executive directors and presidents from the stateassociations (Constituent Member Associations/CMAs)and is an advisory body to theHouse ofDelegates. PartofthisweekendmeetingfocusedonwhatPresidentPattonreferred toas the“elephant in the room”–thatbeing trustbetween the CMAs and ANA. This was largely falloutfrom the historic House of Delegates in June when theMichigan delegates walked out and the subsequentdisaffiliationofafewCMAsfromtheANA.Sessionsweretenseattimes,butconcernswereexpressedopenlyandtheAssemblyendedonaunitedandhopefulnote.

AshardasNHNA’sstaffandvolunteershaveworkedthisyear, there is still a lotwe need to accomplish.My goalis todoubleourmembership in2009 tohelpus continueandexpandwhatweoffertothenursingprofessionintheState.We have worked hard to gain sponsors for eventsandrecruitnewmembers,butwearefallingshort.Ifeachcurrent member recruited one new member, we couldreachthattarget.IimploreallNHRN’stoconsiderNHNAmembershiptosupportourworkonbehalfofNHnurses.

Letter from the President continued from page 2 AVH Employee Earns Emergency Department Nurse

Certification KarenPeabodyofAndroscogginValleyHospitalrecentlypassed her CEN (Certification for Emergency Nursing)Exam, making her a Certified Emergency DepartmentNurse. Certification is dependant on the nurse’sability to complete at least 128 medical tasks in areasincluding cardiovascular; gastrointestinal; genitourinary/gynecological /obstet r ica l; maxil lofacia l /ocula r;neurological; orthopedic/wound; psychological/social;respiratory;patientcaremanagement;shock/multi-system;medical emergency; professional issues; and substanceabuse/toxological/environmental.

Karen, a graduate of Hudson High School in Hudson,Massachusetts, earneddegrees frombothFitchburgStateCollegeandNewHampshireCommunityCollege.ShewashiredbyAVHinJune,1994asaGraduatePracticalNursein the Medical/Surgical Unit. She continued to work inthatUnitwhilepassingherNewHampshireStateBoardstobecomeaRegisteredNurse.ShehasalsoworkedintheHospital’sHomeHealthandEmergencyDepartments.Shehas been a part of the Emergency Department team forseveralyears.

“The entire staff of Androscoggin Valley Hospital isveryproudofKaren’saccomplishment”commentedRussKeene,AVHCEO.“Sheisacredittothisorganizationandconsistentlydisplaysgreatservicetothoseinneed.”

• Extendedreleasebetablockersmaybebettertoleratediftakenatnight(hs).

• ACEinhibitorsare indicatedwithin the first24hoursoftheonsetofmyocardialinfarctionsymptoms.

• ACEinhibitorsshouldbetakenonanemptystomach,1hourbeforeortwohoursaftereating.

• When using nitroglycerin spray, spray first 5 primingsprays into air for first use; one priming spray if notusedfor6weeks.Donotshakespray.Afterusedonotrinsemouthfor15minutes.

—CarmenPetrin,MS,APRN,BC

• Polypharmacy is common for palliative care patients.The risk of drug interactions increases to 90% forpatientson9ormoremedications.

• Opiods slow GI motility and dry out stool. Startlaxativeswhenstartingopiods.

• Tube feedings in terminally ill patients have neverbeen shown to prolong life. TPNhas been associatedwithdecreasedsurvival. IVfluidsareassociatedwithincreasedsecretions,ascitesandpleuraleffusions.

—CarolynCrosby,MD

• Therearecurrently14importantvaccines.• Chickenpoxvaccinebooster(Varivax)isrecommended

forchildrenbetween4–6yearsold.• Zostaavax, approved for individuals over age 60, can

cut the risk of shingles by 60%, as well as reduceseverity.Itisalivevirusvaccine.

• OnemillionnewcasesofgenitalwartsintheUSeachyear.

• AgelimitforGardasilis26yearsold. —WendyWright,MS,ARNP

ANA President Opens ConferenceRebecca Patton, President of the largest nursingprofessional organization in the United States, openedtheNewHampshireNursesAssociation’s fallconference.Patton,ANApresident,was re-elected by the constituentmembersattheJuneHouseofDelegatesforasecondtwoyear term. An OR nurse who practices in Ohio, Pattonreminded participants of the mission of ANA and theroleofNHNAinbeingthevoiceforprofessionalnursing.She stressed the link between nurses and patient safetyas reflected in the nationally collected data on patientoutcomes.GoodsportthatBeckyis,sheallowedherselftobe“raffledoff”and6drawingwinnersgottohave“LunchwiththePres.”

“I’ve been going to nursing conferences for 15 years and this was the best one I’ve ever attended!”

—Sarah, RN

“Everything was great, informative and organized!”

“Enjoyed diversity of topics—excellent conference!”

“Nicely presented—lunch was a bonus—would definitely attend another NHNA conference.”

Experts Inform Nurses continued from page 1

Fall Conference photos continued on page 4

Sullivan County Health Care

Don’t miss this chance to join a caring, progressive team of health care providers. Come and talk to us

about filling one of these positions still left:

• LNA 3-11 shift• LPN & RN days & evenings available

Full & part-time are available.

IV certification and experience is preferred for nurses, but we will train. Excellent benefits and

competitive wages. This is an opportunity you do not want to pass up.

For more information, or to set up an interview, please contact

Rebecca Trudelle(603) 542-9511 or

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Full Time Faculty Position in Nursing

The Department of Nursing at Saint Anselm College has an immediate opening for a full time tenure track position in the Baccalaureate Nursing Program. A PhD in Nursing or current enrollment in a doctoral program is required. Applicant should have demonstrated experience in teaching and clinical expertise in related field. Review of applications will continue until the position is filled. Salary based on experience and qualifications. Please submit cover letter, current CV, three letters of reference, and official graduate transcripts to Dr Sharon A George, Dean of Nursing, Box 1745, Saint Anselm College, 100 Saint Anselm Drive, Manchester, NH 03102-1310.

Saint Anselm College is a Catholic liberal arts college in the Benedictine tradition dedicated to educating students for a diverse world. Support for the College’s mission is expected. Saint Anselm College is an EOE.


Breakout session on immunization.

Mother Nature’s Pharmacy.

Ginny Blackmer, Jim Biernat and State Rep Laurie Harding.

Immunization speaker, Wendy Wright.

Presenter Carolyn Crosby.

Presenter Steven Ottariano.

Presenters Carmen Petrin and

Donna Pelletier.

Fall Conference photos continued from page 3

Keynote Speaker, ANA President, Becky Patton.

Donna Pelletier & Sue Fetzer.

More exhibitors.

Attendees visit exhibitors.

One of our sponsors - Sanofi Pasteur.

Diabetes presenter, Liz Kennett.

Annual Meeting.

Anita Pavlidis & Doris Nuttelman enjoy the conference.


Avery Morgan, Executive Director

Idon’tknowaboutyou–butI’dliketoshedthe12poundsthat have crept on this year… PLUS the 12-15 from the prior decade, actually!Therewasa time that Icouldeatanything and not worry about it (ok–so I was 19 then!)butnow,post-menopausal (loathsomephrase), I thinkmymetabolism has slipped into a coma. This body is justnot cooperating. It’s morphing… shifting… spreading…holdingontoeach tastymorselof fator sugar that Ihaveeitherwillfullyorabsentmindedlyallowedtopassmylips–andI’vejoinedthe‘sisterhoodoftheelasticwaistpants’.(Soon to be ‘sisterhood of the traveling Spanx’.)

When heading out on holiday errands yesterday I foundmyself pulling into a coffee-doughnut drive throughthat shall remain nameless (but the initials are D-D)and ordering a latte plus doughnuts. Driving away Ithought, “Well this is probably not my best weight-lossstrategy…”but consumed the lot anyway.After finishingsomeshopping I realized itwaswellpast lunch timeandI succumbed tomore “fast food fat”, this time in burgerform–somethingIhadtotallybanishedfrommylifeforseveralmonths,butthenfelloffthechuckwagon.

Next Iproceeded to spend the restofmySaturdaydoingsomework at the computer, then catching aDVDmovieand a couple of favorite TV shows. (I’m looking for analternative to the term “couch potato”… but “sofa spud”or”loveseat lump”aren’tanybetteranddon’tchange thebasic problem.) I glanced at the exercise equipment inthe corner ofmy bedroom and thought, “I should reallygobacktousingthat…”–havingboughtasmallTVlastwinter solely to inspire ‘workingout’whilewatching themorning and evening news. (I think that plan lasted aweek.)However, it doesn’t have DVD capability… so–off to the living room couch.

Inanutshell,lifeatbothworkandhomehasbecomequitesedentary (frombed tochair tocar tocomputer tocar tocouch to computer… back to couch… to bed… and soon)aswellasprone tomoreon-the-flyconveniencefoodconsumption.AndIknowbetter.IknowIfeelbetterwhenIeliminatecertainfoodsandeatmorefruitsandveggies;drinkmorewater thancoffee,walkmore in the freshairand get regular sleep. If you’re also someone who hasfallenintolessthanhealthyhabits,Ihavenodoubtthatasanurseyou‘know’betteraswell.

But translating that ‘knowing’ into action is where weoftengetstuck,isn’tit?

CLOSE YOUR EYES, BREATHE DEEPLY AND RELAX…

WhatIlearnedduringseveral years ofstudying, practicingandteachinghypnosis,is that it’s not reallyour conscious mindthat drives behavior–as much as we’d liketothinkwearealwaysin conscious control.I used to use a largeblowupofthisicebergphoto for a simplisticvisual analogy ofthe conscious vs.subconscious minds.The 5-10% of anicebergthatisactually

visibleabove thewater’s surface represents theconsciousmind. The SUBconscious, on the other hand, is morelike thegreatmassbeneath–whichdirects the ice flow.The subconscious includes theautonomicnervous systemwhichcontrolssomuchofourphysicalfunctioning.Italsostoresallourmemories(asineverythought/experience/dreamwe’veeverhad–oftenincludingin-uteromemory);ouremotions;ourbeliefs (aboutourselves,othersand theworld around us); our motivations, habits / addictions…etc. So which part do YOU think is really guiding your life / direction / behavior?

For more of a computer age analogy, the subconsciousmindwould be like a collection of software programs…some running on screen…. some running butminimizedand out of site… some dormant but easily triggered byeven an inadvertent click… somewith operating glitchesor viruses. In brief, our beliefs and habitual behaviors /responsescomefromour‘programming’…and, the good news–canbereprogrammed/debugged!

Itisoftenjustasmallincident,belieforassociationstuckinthesubconsciousthatsabotagesusandwhatwe‘know’onaconsciousleveltobebestforus.Inthecaseofweightissues, it can be as basic as an oldmemory that equatesfoodwithlove–orprotection–orcontrol–orguilt(storiesof those starving3rdworld children cleanedmanyplatesin the States!)As a nurse it’s often easier to think aboutothers than yourself – (‘the patient comes first’… ‘myfamilycomesfirst’…)andthatinitselfcanbedetrimental.

Ifyouhaveeverfoundyourselfinayo-yocycleoftakingoffunwantedpoundsonly tohave themshowupagain–bringingfriends–youmightconsiderfindingagoodlocalhypnotherapist.(IfonlyOprahwouldreadthis!!)Oftenjustafewsessionsareallittakestoexorcise(figuratively)thatinner‘saboteur’andcreatelastinghealthfulchange.(Alsoexcellent forsmokingcessation.)I’m personally not a big believer in the one night hotel hypnotist method–though that can be enough for some highly motivated individuals. Agoodtherapistwillteachyouselfhypnosisskillstouseonyourown.

WATCH YOUR LANGUAGE!

Whether or not you choose that route to a slimmer self,letmejustsharejustafewtipsaroundsemanticsthatcanmakeadifferencetoyoursuccess.Whenstudyinghypnosisyou learnhowmuch language reallymatters because thesubconscious mind can be very literal. For example, themind typically does not like to “lose” anything–so thevery term “WEIGHTLOSS” can be self defeating. Shiftthat thought to either “releasing” those extra pounds–orpreferablyjustaffirmandvisualizeyouridealweight.

Also–just consider the first 3 letters of thewordDIET…hmmmm… who wants to go there?! So think instead intermslike“eatingplan”orhealthiernutritionchoices–andgradually it will become second nature to gravitate tothosefoods.Creatingalistof“can’thave”forbiddenfoodscan resulta resentful,deprivedsubconscious that triggersrebelliouseating–evenbingeing–andsendsyoucompletelyoffcourse.

Bewaretheword“TRY”…asin“OK–I’llTRYthatdiet…”or“I’llTRYhypnosis...”etc.Itpresupposesfailureandisoften away to justify some inability to change. (“I triedthat–ITdidn’twork.”)Youdon’thavetoknowZen–onlyYoda–tohaveheardthephrase:“ThereisnoTRYthereisonlyDOornotdo.”

Catchyourselfifyoueversayorthink“Iamfat”…”Iamoverweight”… “I am __(anything negative)___” for “I

AM”isapowerfulaffirmation–andanythingthatfollowsis believed and clung to by the subconscious. Instead gofor phrases like “I AM making better choices every day for a long, healthy, happy life” which is fairly ‘allpurpose’.For affirmations in general, that present tense is important. Couching goals in terms of “I will________” puts them always in the future and never achieved. Thebest time for positive affirmations / visualization? Justbeforedriftingofftosleep–andimmediatelyuponwakinginthemorningwhenbrainwavesareintheAlphatoThetarange(astateofnaturalhypnosis)andthesubconsciousishighlyreceptive.(Which is also why it’s NOT a good idea to fall asleep or wake up to the TV “badnewscast”!)[Note:for thoseofyouworkingonsmokingcessationfor2009,thesesamebasicconceptsapply:you’renot“givingup” cigarettes, you are choosing to be a healthy NON–SMOKER, and ‘reprogramming’ that behavior is mucheasierinareceptivehypnoticstate.]

Generally counterproductive is obsessing about the scale.Assimplisticasitmayseem,what we focus on E X P A N D S–including weight / waistline! Put the scale away.You’ll know you’re slimming down by the way yourclothes fit. Shift your focus from pounds and inches tomaking those healthier choices about food and exercise–“onedayatatime”,andyou’llfindyourselfmovingmore,consuminglessandshoppingforsmallersizes!

Keepinmindthisisnotintendedasanallinclusive‘howto’program–justafewcentraltipsthatIhopeyou’llfindhelpful. Isharetheminpartbecause“we teach what we need to learn” –or relearn in this case.So here’s to a great and healthy New Year for all of us!

Now where did I store those self hypnosis tapes? (Yes–I’ll work on memory next…)

Those ‘WEIGHTY’ Resolutions…


The NHNA Board of Directors recently endorsed a position statement advocating “BSN in 10.” An article in the August, 2008 issue presents the resolution and argues that the nursing profession and recipients of health care would benefit from a higher educated workforce. NH Nursing news received a single response on the position, printed below. It is noted that under the BSN in 10 proposal, any nurse already practicing nursing in the state would NOT be affected, and only affect those entering nursing programs after any law would be passed. Critical to the proposal is the development of articulation agreements, financial resources and differentiated practice patterns.

The mission of the New Hampshire Nurses Association is to promote the nursing profession to improve the health of all citizens. In the late 1970’s, NHNA supported the sunsetting of the hospital diploma schools of nursing in New Hampshire. As a result, nursing was removed from under the direction of hospital administration and provided with autonomy in education. This decision was not popular at the time, and created angst among diploma registered nurses. However, those nurses when asked today often reply that it was an action that promoted the identity of nursing as a profession.

The New Hampshire Nursing News invites responses to this or any position and therefore shares with readers the following letter.

”Icomefromanursing family.MyAuntwasanurse for48years.Mymotherinlawwasanursefor45years.Myhusbandwasanursefor20years,andwouldhavegoneonanother15-20years ifdeathhadnot takenhimfromme.Imyselfhavebeenanursefor24years,sofarmyson isin nursing school right now. My nephew just graduatedin May, and another niece is considering starting at aprogramin2009.AsIsaid—weareanursingfamily.AndonlyoneofushastheBSNyouseemtothinkisnecessarytoprofessionalpractice.

“Idonotsupportyourorganizationforoneprimaryreason.YoupressforthatBSN.Yousayyoudon’t,thatthey“onlyhavetogetitwithin10yearsofgraduation”butitseemstomethatallofthefolksinmyfamilywithamorethan10yearsofworkhistorywouldhavebeenforcedoutofbeingapracticingRNbecauseoflifeevents.

“Mymotherinlawwaswidowedandalonewith6children10yearsintohernursingcareer.Myauntdevelopedbreastcancer at about that time. My own father developedAlzheimer’s and required considerable care at home.Myhusband chose to work full time and put his education/careerambitionsonholdsothathecouldbepresentinhischildren’s lives. It must have paid off—as I said, one ofthemisinnursingschoolnow.

“Torecapbriefly,adecisiontomandateaBSN,evenjust10 years into a nursing career, would have deprived thestateofNHof97yearsworthoffulltimenursingservices.Andthatisjustmyownfamily.Youclaimtowanttohelpwith the nursing shortage. But with tactics like these, IguessIjustcan’tseeit.AnduntilIdoseeit,andyoudropthe educational notions and focus on the actual work ofnursing,youcancountmeoutintermsofmembershipandsupport.”

LoriWilkerson,RNManchester,NH

A Nurse Responds

School Nurse Victory

SILVER SPRING, MD—The American NursesAssociation(ANA)achievedamajorvictoryinaCaliforniaSuperiorcourttodaybyobtainingacourtordertostoptheunlawfuluseofunlicensedpersonneltoadministerinsulintoschoolchildreninCalifornia.JudgeLloydG.Connellyissued a ruling in the legal case, American NursesAssociation,etalvs.JackO'Connell,StateSuperintendentofPublic Instruction,elal immediately followinganoralargumentinwhichhestatedthattheNursingPracticeActinCaliforniaisthespecificstatutethatgovernsthescopeof nursing practice and that the issuance of a CaliforniaDepartment of Education directive that was contrary tothat Act cannot be implemented. Judge Connelly statedthattheDepartmentofEducationdoesnothaveconcurrentauthority over the administration of medications andcannot override the Nursing Practice Act. Only personsspecifically authorized to administer insulin are allowedto do so. The court gave deference to the interpretationof theCaliforniaBoardofRegisteredNursingwhichwasconsistent with ANA’s view. The court further held thatfederallawdoesnotpreemptstatelaw.Thejudgedeclaredthat the actions of theDepartment of Education violatedthe state’s Administrative Procedure Act by failing topublish for notice and comment the legal advisory thatattempted to permit unlicensed personnel to administerinsulin.

“Our faith in the judicial system has been well placed,because the judge recognized that the scope of practiceforregisterednursesisestablishedbytheNursingPracticeAct, with oversight by the Board of Registered Nursing.We are pleased that the judge specifically stated that theDepartment of Education did not have authority to re-define the scope of practice for registered nurses, evenregardingissuesthatariseintheschools.”remarkedANAPresidentRebeccaM.Patton,MSN,RN,CNOR.

“This isavictory forall registerednurses,becauseANAanditsco-plaintiffs,ANA/CandCSNO,haveestablishedthat state agencies cannot play fast and loose with thescopeof practice for nurses.This is especially importantwhenweare trying topreventunlicensedpersonnel fromadministering insulinwhen that is not permittedby statelaw.ThechildrenofCaliforniadeservethebesthealthcareandANAhashelpedthemachievethat,”saidANAChiefExecutiveOfficerLindaJ.Stierle,MSN,RN,NEA-BC.

ANA and its co-plaintiffs, ANA/C and CSNO, fullysupportstudents’rightstopubliceducationandappropriateaccommodations for their health needs. ANA contends,however, that the California school system must complywith local laws inproviding reasonable accommodations.The Nursing Practice Act specifies who may administermedication, and the exceptions to that are specificallydelineated.

Improving Performance Measurement and Public Reporting in the United States

The American Nurses Association (ANA), the NationalQuality Forum (NQF), along with representatives of26 other major national health care organizations willjoin forces on Monday, November 17, 2008, by publiclyreleasing its report, Aligning Our Efforts To Transform America’s Healthcare Goals designed to set nationalpriorities and goals to achieve a high-performing, healthcaresystemdeliveringqualitycaretoall.

"TheNationalPrioritiesPartnershiprepresentssomethingunique in health care—a diverse range of high-impactstakeholders working to align their efforts on a core setofhigh-leverageareasofimprovement.Itisimportantforall partnerships related to health care quality to includethe perspective of registered nurses order to transformthe health care system.Nursing is the largest componentof the health care workforce and provides the greatestamount of direct patient care. This collective force willdeliver fundamental and transformative improvements toAmerica’shealthcaresystem,”saidANAChiefExecutiveOfficerLindaJ.Stierle,MSN,RN,NEA-BC.

The priorities and goals of the partnershipwere selectedtoaddressfourmajorchallenges inhealthcare:eliminateharm, eradicate disparities, reduce disease burden, andremove waste. The Partners focused only on NationalPriorities andGoals that would, if implemented broadly,dramaticallyimproveournation’shealthcarequality.

Workingtogetherthepartnerswill:• Engagepatients and their families inmanaginghealth

andmakingdecisionsaboutcare• Improvethehealthofthepopulation• Improve the safety and reliability of America’s

healthcaresystem

• Ensurepatientsreceivewell-coordinatedcareacrossallproviders,settings,andlevelsofcare

• Guarantee appropriate and compassionate care forpatientswithlife-limitingillnesses

• Eliminate waste while ensuring the delivery ofappropriatecare

The Partnership’s core list of priorities will yield realdividendsintheformofimprovedcare,equity,safety,andefficiencyoverthenextthreetofiveyears.Theabsenceofnationalprioritiesandgoalsforperformanceimprovementimpedes the efforts of those involved in all facets ofperformance measurement, improvement, and reporting.A sizable amount of resources and energy are currentlybeing invested in the development of performancemeasures by many organizations including accreditingbodies, professional societies and boards, governmentorganizations,andothers.

To date, NQF has endorsed approximately 400performance measures and practices, and many moreare in the “measure pipeline,” some in the early stagesof development and others moving through the NQFendorsement process. In spite of all these activities, it isunclearwhetherattentionandresourcesarebeingfocusedon “high leverage” areas—aspects of performance forwhich improvementwillyield thegreatestgains in termsof better health and healthcare. ANA recognizes thatnational priority-setting must be a collaborative processwithotherkeystakeholderswhoengageinpriority-settingefforts of their own. In response, the National PrioritiesPartnershipwasestablishedtoaddresstheseconcerns.

Formoreinformation,pleasevisithttp://nursingworld.org/HomepageCategory/NursingInsider/ANA-Works-Toward-a-Consensus-Agreement.aspx.

The American Nurses Association Works Toward a Consensus Agreement on a

Core Set of National Priorities in Health Care

Nurses. Nurses. Nurses.HealthcareHeadhunter

Sendresume:[email protected]

(p)603-410-3911•(f)603-410-3906

www.providerman.com


by Diane E. Scott, RN, MSN

Being happy at work is a fundamental element of aperson’s life satisfaction. Because work is an integralpart of a person’s identity, the professional role that oneassumes is frequently themeansbywhich a person feelsthemost valued and derives their self-esteem. (1)Withinthe profession of nursing, there is a positive correlationbetween career satisfaction, self nurturance, and lifesatisfaction.(2) Given work’s powerful influence in themeasureofone’sself-worth, isseems toreason that therearesignificantpositiveoutcomesofexperiencinghappinessatwork.

The business case for happiness at work

Experiencing happiness at work not only producessignificantpersonalconsequencesforemployeesbutisalsoa factor forbusiness success. (3)Business andhealthcareorganizations are recognizing the direct connectionbetween employee happiness and enhanced productivityand improved outcomes. Jessica Pryce-Jones is the co-founder of iOpener, aBritish based firm thatworkswithbusinesses around theworld to increase their employee’shappiness. “Businesses and teams often focus on successand assume that people will be happy as a result, butsuccess is not the same as happiness. It will not lead tolong-term business commitment, loyalty, or motivation,whereasbeinghappyatworkdoes.”Businessesvalueherfirm’s mission as demonstrated by Pryce-Jones’ growingclient list that includes the World Health Organization,ShellOilandBaxterHealthcare.

The time you spend at work

Beinghappyatworkisimportant,inpart,becausepeoplespend the majority of their time working. According totheU.SDepartment ofLabor, during thework-week, theaverage employed American spends more time workingthanwith any other activity of daily life. (4)Because somuchofaperson’sdailylifeisspentatwork,itbehoovesapersontoreallylookatthenatureofwhattheydowhiletheyareatwork.

“A person will not be happy with their job if they arespending too much time in activities that do not engageand energize them,” states Pryce-Jones. She affirms thatif an individual spends the greatest percent of their daydoingwhatmakes them happy, they becomemuchmoreproductive and committed. “You really can completetasks much more efficiently and to a higher standard ifamajority of your day is spent on thework that ismostmeaningfultoyou.”

Job satisfaction verses happiness at work

Eachyear,healthcareorganizationsspendcountlessman-hours and considerable financial resources measuringemployee satisfaction. Information obtained by thesesurveys can be valuable, but the danger exists whenemployees do not see concrete actions as a result of theinformation(5)

Pryce-Jonesnotesadistinctdifferencebetweensatisfactionand happiness. She says, “Themajor difference betweenemployeesatisfactionandhappinessiscontrol.Satisfactionisdeterminedbyfactorssuchaspay,workingenvironment,and benefits. Happiness is a part of job satisfaction butreally concerns what you can control and influence.”Pryce-Jonesclarifiesthatcontrolisafundamentalelementofhappinessatwork.“Whatpeopleareinmostcontrolofisreachingtheirownpotential.”

The journey of happiness

Determining how to reach one’s own potential andlearningwhattrulymakesthemhappyisanindividualizedprocess.Itisuniqueforeverypersonbecausepeoplebringwith themahostofpastexperiencesanda full spectrumof natural tendencies. When healthcare organizationsimplement a one-size fits all strategy for employeeretention, their well-intended efforts often garnish fewconcrete results becausewhatmakes a personhappy and

fulfilled is different for each individual. The greatestsuccess will come by focusing on helping an employeewiththeirpersonaljourneytohappiness.

A daunting task for nurses

Because caring for other’s needs first and foremosthas been the venerable mantra of nursing, it is not thetraditional nature for a nurse to focus on their ownemotional well-being. The journey to happiness at workmayseemtobeadauntingtask.

Keeping in mind that every nurse’s journey to careerhappinessisdifferent,theCenterforAmericanNurseshasstartedauniqueinitiativedesignedtoassistnursesincreasetheir career self-awareness and discoverwhat gives themenergyandmeaningatwork.

In the fall of 2008, theCenter forAmericanNurseswilllaunch a career coaching program. Career coaches arenot recruiters, but professionals with specific training inassisting people to discover their unique skills, talents,and passions. Through individual phone conversations,they provide tools to guide in the self-discovery processand help people consider career choices that will makethem themost happy. These services are designed to beconvenientandaffordable,butmostofall,designedwithamissiontohelpindividualnursesdiscoversuccessintheirjourneytocareerhappiness.

For more information, please go to www.centerfor americannureses.org. Diane Scott, RN, MSN is the President of the Nursing Mentors Group and a consultant with the Center for American Nurses.

1.Gini,A.(1998).Work,IdentityandSelf:HowWeAreFormedbyTheWorkWeDo.Journal of Business Ethics,17(7)7707-714.

2.Nemcek,MA. (2007)Registered nurses' self-nurturance andlifeandcareersatisfaction.AAOHNJournal.55(8).305-310.

3. Boehm, J.K. and Lyubomirsky, S. (2008) Does HappinessPromoteCareerSuccess?Journal of Career Assessment,16:101-116.

4. U.S Department of Labor. http://www.bls.gov/tus/charts/AccessedSeptember2008.

5. Lusty, D. (2007). How to avoid the pitfalls of employee-satisfactionsurveysHuman Resource Management International Digest.15,(6),pg.3.

Center for American NursesNursing That Works

Happiness at Work

The American Nurses Association Launches New and Improved Web Site

for Nurses Site features improved usability and

navigational elements

SILVER SPRING, MD—The American NursesAssociation (ANA) has launched a re-designed Website, GeroNurseOnline.org that is designed to serve asa comprehensive, rich resource for nurses and the publictheyserve.

“ANA’s GeroNurseOnline.org Web site provides nurseswith resources regarding clinical information, educationand career certification instrumental in providing carefor older adults, regardless of specialty. We encourageyou to explore theWeb site and stay informed of trendsand developments in geriatric care,” saidANAPresidentRebeccaM.Patton,MSN,RN,CNOR.

TheGeroNurseOnline.org’snewfeaturesinclude:• Careeropportunitiesingeriatricnursing;• Links to 55 specialty nursing associations’ clinical

offeringsingeriatriccareandgeriatricwebsites;• Resourceorganizationsandrelatedresourcematerials;• Hospitalcompetenciesforcaringforolderadultsforuse

innurseorientationandevaluation;• Online courses to prepare for ANCC gerontological

certification;and• ANAadvocacyworkonbehalfofgeriatricnurses.

GeroNurseOnline.org is the official geriatric nursingweb site of the American Nurses Association (ANA). Itwas developed through the Nurse Competence in AgingInitiative,toprovideinformationregardingnursingcareofolderadults.TheNurseCompetenceinAgingInitiativehasbeenfundedbyagrantfromtheAtlanticPhilanthropiestotheAmericanNursesFoundation.

The ANA is the only full-service professional organization representing the interests of the nation's 2.9 million registered nurses through its 54 constituent member nurses associations. The ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.


Nurse Practitioner, Leslie Goldman,

ARNP, Joins Keene Practice

Cheshire Medical Center/Dartmouth-Hitchcock Keenewelcomes Leslie Goldman,ARNP, to the Department ofFamilyMedicine. Ms. Goldman has 25 yearsof experience is a familynurse practitioner providingprimary care to individualsfrom adolescents to the elderly.She has been instrumental inimplementingspecifichealthcareimprovement in primary careand chronic diseasemanagement in hospital and clinicalsettings. Ms. Goldman has also served as a preceptorof Nurse Practitioner students from the Universities ofMassachusetts,VermontandHawaii. Ms. Goldman earned a Master of Public Health at TheDartmouthInstitute,Hanover,NHandaMasterofScienceinNursing/FamilyNurse Practitioner atMedicalCollegeof Virginia, Richmond, VA. She completed a Bachelorof Science in Nursing at Downstate Medical Center,Brooklyn,NYandaBachelorofArtsinBiologyatClarkUniversity,Worcester,MA.HerprofessionalmembershipsincludetheAmericanNursesAssociation.

DURHAM, N.H.—The calm, quick reaction of aUniversityofNewHampshirenursingstudenthelpedsaveapatient'slifeatExeterHospitalinNovember.

Katherine Boucher, a junior from Lee, was providingdirectcaretoapost-operativepatientduringhermedical-surgicalnursingclinicalatExeterHospital.Shenoticed—before the patient did—that the patient was bleedingheavilyfromhissurgicalsite.Thinkingquicklyandactingcalmly, she attempted to stop the bleeding with sometowelsthatwerenearbyandinstructedthepatienttokeeppressure on the towels before summoning a professionalnursetoassist.

"Thepatienthadanangelwatchingoverhim,"saysBethEvans, the UNH clinical instructor overseeing Boucher,adding that the bleeding was so heavy that the patientwouldlikelyhavegoneintoshocksoonwithoutBoucher'scare.Suchlife-or-deathscenariosarenearlyunheard-offorstudentnurses,whodonotcareforcriticalpatients.

"Manystudentswouldhaverunouttogettheirinstructor,whichisone‘rightanswer,'"saysUNHassociateprofessorofnursingSueFetzer,whoteachesthecourse."ButoneofthethingsIhavestressedinthiscourseissettingprioritiesandmakingdecisionswhenalltheanswersarecorrect.Inthiscase,thebestanswerwaswhatKatherinedid,stoppingthebleeding."

"She did exactly what a licensed R.N. would do," Evansadds.

Northeast Rehabilitation Hospital,locatedinbothSalemandNashua,isproudtoannouncetheaccomplishmentsofthefollowingRegisterednurses.

AttainmentofClinicalLadderTwo:Karen Mason, Cheryl Marin, Denise Rogers, MelissaLoader,CarolineRossi,KathyGillis,NancyGoes,SusanHabaj

Leslie Goldman

Junior Nursing Student Rescues PatientBouchercreditshertrainingaswellasinstinctwithhelpingher stay calm. "Panickingwas not only going to preventmefromthinkingclearly,butIwasalsoconcernedaboutgetting the patient panicked," says Boucher. "That couldhaveescalatedbloodpressureandheartrateandmadethebleedingworse.Itwasdefinitelyimportanttokeepmyselfand the patient calm." Boucher was so cool-headed, shesays, "that the nurse I called toldme she thoughtmaybethepatienthadjustscratchedascab."

AsnewsofBoucher'slife-savingworkspreadsandcausesexcitement among her classmates, professors, and eventhe dean of the College of Health and Human Services,Boucher retains thatsenseofcalm."This isour job,"shesaysofherself andher fellownursing students. "It'swhatwe'resupposedtodo.It'sveryimportantandobviouslythepatient involved is very appreciative, but things like thishappeneveryday.We'reluckytohavehadthisexperiencetolearnaboutit."

"I'm really grateful to be at Exeter Hospital," she adds."Thenursestherearereallywonderfulwithstudents."

Boucher,daughterofPhilandPennyBoucherofLeeandagraduateofOysterRiverHighSchoolinDurham,hasbeenin UNH's highly competitive nursing program since shewasafreshman.Shehopestobecomeanurse-midwife.

The patient, who was returned to surgery to repair thewound,isnowrecovering—againinBoucher'scare.

Northeast Rehabilitation HospitalThe following nurses received their certification inRehabilitation Nursing this past summer: Denise RogersRN,BethSchefflerRNandJenniferTuckerRN

The Homecare Division of Northeast Rehab is pleasedto announce that Karen Baggetta RN received hercertificationasawoundcarespecialist.


New Domestic Violence Protocol

for Healthcare Professionals

The state of New Hampshire Governor’s Commissionon Domestic and Sexual Violence has recently releasedan updated domestic violence protocol for healthprofessionals: “Identification and Treatment of AdultVictims.” The protocol is designed to provide healthcareproviderswith information about domestic violence, howtorecognizevictimsandhowtoassistthem.Itisapplicablefor emergency departments, private medical offices andoutpatientclinics,familyplanningclinics,dentists’offices,and other healthcare providers such as chiropractors orphysicaltherapists.

Each year in New Hampshire, nearly 11,000 victims ofdomestic and sexual violence contact crisis centers forassistance. The U.S. Surgeon General’s office has citeddomestic violence as one of the major health problemsfacingAmericanfamiliestoday.AccordingtoastudyfromtheCentersforDiseaseControlandPrevention,publishedintheFebruary2,2008issueofMorbidityandMortalityWeeklyReport,domesticandsexualviolencearepervasiveandcostly,andcancreatehealthproblems thatcan lastalifetime. Many women are too embarrassed or afraid toadmitthecauseoftheirinjuries.Othersarereadytotalk,but are confronted with disbelief or blame. Still othersareonlywaitingtobeasked.Asmanyas75%ofbatteredwomensaytheywouldhavetoldanurseorphysicianaboutthedomesticviolenceiftheyhadbeenaskedthequestion.

Thepurposeof thedomestic violenceprotocol for healthprofessionals is to assure that women and men whopresent in healthcare settings are screened for domesticviolence and provided with comprehensive medical andpsychosocial interventions as indicated. It is the goal oftheNHGovernor’sCommissiononDomesticandSexualViolence that all healthcare providers will be orientedto the domestic violence protocol and be familiar withthe problem and indicators of such violence. For furtherinformation or copies of the protocol, please contactHeather L. Farr at 603-224-8893 ext. 307 or [email protected].

America does only a mediocre job caring for its sickestpatients. The nation, says a new report, gets a "C."New Hampshire gets an "A." The Journal of PalliativeMedicine, in theOctober2008 issue,published thestudyby the Center to Advance Palliative Care and NationalPalliative Care Research Center. Only New Hampshire,Montana and Vermont earned an "A,” according toAmerica'sCareofSeriousIllness:AState-by-StateReportCardonAccesstoPalliativeCareinourNation'sHospitals.Three states—Alabama,Mississippi and Oklahoma—gotan"F."

Nursing Students Helping the Community

Students at the Mass. College of Pharmacy & HealthSciences set a goal of creating 25 Thanksgiving dinnerbasketsforfamiliesintheManchesterarea–andmanagedto more than double that goal with a total of 63! Thegroup then loaded up their creations and delivered themto Saint Anselm College, which has partnered withCatholicCharitiesandGreaterManchesterAIDSProject.The campuses’ combined efforts gathered 230 basketsto provide families in the city of Manchester with atraditionalThanksgivingdinner.

New Hampshire Receives an “A” in Palliative Care

NinetymillionAmericansarelivingwithseriousillnessessuchascancer,heartdisease,diabetes,Parkinson's,strokeand Alzheimer's. As the baby boomers age, this numberwillmorethandoubleoverthenext25years.

"The good news is that hospitals nationwide haveimplemented palliative care programs quickly over thelastsixyears,"saidR.SeanMorrison,MD,directorofthestudy.

Thestudysuggeststhatinstateswithmorepalliativecareprograms, patients are less likely to die in the hospital;don'thave togo to the intensivecareunitasmuch in thelast sixmonthsof life; and spend fewerdays in intensivecareor thecoronaryunit in the lastsixmonths.Forstateratings,thereportandrecommendations,goto:www.capc.org/reportcard.

Palliative care canwork bestwhen patients are providedwith the opportunity, early in their illness, to exploretheir life goals, their requirements forwellness andwell-being,andhavingcontrolovertheirdisease.Theybecomeaware that theymay not be able to prevent symptoms oftheirillness,buttheycancontrolhowtheydealwiththeircondition.Hospitalpalliativecareprogramsmakepatientsfacing serious and chronic illness more comfortableby alleviating their pain and symptoms and counselingpatientsandtheirfamilies.Withoutpalliativecare,peoplewithseriousillnesseslikecanceroftensufferunnecessarilyfromseverefatigue,pain,shortnessofbreath,nauseaandothersymptomsfromtheirdiseaseandtreatments.

The palliative care group at Cheshire Medical Center/Dartmouth-HitchcockKeeneworksaspartofalargergrouppracticeincludingoncologyandgeriatricmedicinetohelpfamiliesandpatientsindecisionmakingrelativetoend-of-lifecare."Themultidisciplinarygroupalsoincludesapainclinicwith specialists in painmedicine, spiritual supportby the hospital chaplain, and close cooperation withHospice at Home Healthcare, Hospice & CommunityServices which makes for excellent medical care andsmooth transitions for healthcare from clinic to hospitaland home," saidPathologist andPalliativeCare provider,Alex Bonica, MD. "This is an excellent situation rarelyavailableincommunitiessuchasours."


by: Susanne Gaddis, PhD, CSP, Elizabeth Cates, M.A.

Withthecurrentnursingshortage,nurseshavealotmorechoices of where they’re going to work and how longthey’regoingtostay.Asbabyboomersretireandyoungergenerations of nurses enter the workforce, gone are thedays where a nurse would start a career and then fourdecadeslaterretirefromthesameposition.Withtherisingdemand for nurses in the coming years, it is crucial tocreateawelcomingandappreciativeatmosphere.

Today, healthcare workers are on the move, and toencourage them to stay in one place, hospitals and nursemanagementarechallengedtothinkofnewandinnovativeideas for creating loyalty and retention. In addition, eachhealthcareworkeralsohastheresponsibilityofcreatingahealthyatmosphereinwhichtowork,onewheretheirco-workerswillwanttostayforthelonghaul.

Asyouareseekingtoincreaseloyaltyandretention,hereare some things to keep both you and your colleaguesmotivated:

Listen.One of the quickestways to increase loyalty andretention is to listen to your colleagues. Peoplewho feelheard are more likely to stay than those who believetheir thoughts, ideas and feelings don’t matter. Listeningalsoworks to build self-esteem, self-confidence and self-efficacy, a person’s belief that he/she can achieve certaintasks.

The last thing someone wants to hear when they bringan idea forward is: “Oh, what do you know? You arenew here. You haven’t had the experience that I’ve had.You haven’t walked in my shoes. I am in charge here!”While these statementsmaybe true, they serve to createwalls,notbridges.Wordslikethesecanhavealong-term,damaging effect on even themost seasoned professional,makingthemwanttorunforthedoor.

Acknowledge Ideas. Although every idea andsuggestioncannotbeacteduponnorall requestsgranted,acknowledgingaperson’sinputcangoalongwaytowardmakinghimorher feel likean integralpartof the team.Not only can you acknowledge the idea, you can alsoacknowledge the thought behind the idea, their uniqueperspective or skill set in formulating the request.All ofthesewillhelptocreateasenseofbelonging.

Takeforexample,Sally,anewCNA,whoduringaroutinevitalscheckdiscoveredapatienthadbeenreceivingbloodpressure medication for several days, even though thepatienthadnopriorhistoryofhighbloodpressure.Aftertalkingwith the patient, Sally determined that the bloodpressurecuffbeingusedwastoosmall,whichcausedthepatient’svital signs tobedrasticallyaltered. Immediatelyshetookthisinformationtomanagementandadjustmentswere made that quite possibly saved the patient’s life.Administration took notice of Sally’s quick problem-solvingandanalyticalskillsandrewardedherpubliclyfor

being a diligent patient advocate. More importantly, herco-workersgaveherbothrespectandpraiseforherabilitytotakecommandinanemergencysituation.

Be A Motivator.Findoutwhatmotivatesyourcolleagues.Thiswillbedifferentforeachperson.Somearemotivatedby praise, while others are motivated by power andprestige.Stillothersareenergized throughmore intrinsicfactors,suchasasenseofpride,meaningandvalue.Thedays of cookie cutter, one-size-fits-allmotivation is over.Toactivelyengageyourco-workers,youneed to findoutwhatworks for each person.Don’t treat your co-workersthewayYOUwanttobetreated,treatthemthewayTHEYwant to be treated.How do you find outwhatmotivatesthem?Askthem!

Be Aware Of Information Overload. Be careful thatYOU are not the cause of your colleague’s demise byover-sharing. Sometimes you can cause undue stress bygetting too in depth about challengingmeetings, hospitalpolitics, andyour latest interactionswithdifficultpeople.Thisdoesn’tmeanyoucan’tshareANYofyourpersonallifewithyourco-workers,but try tokeep thenegative toaminimum.After all,most people have enoughon theirplatewithoutkeepingupwithyourstresses.

Agoodruleof thumbis to tryandkeepconversationsaspositive and productive as possible. The latest researchsuggests that for every negative comment we make, weshould say at least three positive statements. By keepingconversations focused onwhat you can do,what you arewillingtodo,andwhatyouhavedone,youcandecreaseacolleagues’stresslevel.

Model The Behavior You Want. Beaware,fromthetimeyou arrive for your shift to the time you leave, you arevisibletoothers.Yourgoalistobeas“positivelyvisible”aspossible.Becomeamodelforthebehavioryouwanttosee in others. Remember that your colleagues often taketheir behavioral cues from you. If you greet them withawelcoming, “GoodMorning,” they are likely to do thesame. If you maintain a professional atmosphere, you’llnoticethattheywillfollowsuit.Yetifyoucallthemoutontheirbehaviorwithoutadjustingyourownbadhabits,theywillseeyouashypocriticalandinsincere.

Focus On Strengths Rather Than Weaknesses. Therehas been a trend for years to harp onweaknesses ratherthan develop strengths. If you look at most performanceappraisal forms, you will first find an area forimprovement.Whilecontinuousimprovementisimportant,wenowknowthatthereareindividualswhowillexcelatcertain tasks. Byworking cooperativelywith others, youcanutilizethestrengthsofeachindividual.

Foradditional information,checkoutNow Discover Your Strengths by Marcus Buckingham and Donald Clifton,Ph.D. or take the Strengths Finder profile at: www.strengthsfinder.com.

Remove Obstacles.Anothergreatwaytoincreaseloyaltyandretentionistoworkdiligentlytoremoveroadblockssopeople can be as productive as possible.By immediatelyaddressing issues involving personal safety, sexualharassment, workplace violence and discrimination, youwillhelpcreateanenvironmentwhereyourcolleaguesfeelcomfortablecomingtowork.

Supportive Care. While you can’t completely changeyour environment, you can promote a sense of supportand care among your fellow nurses to help them copewiththevarietyofdifficultsituationstheyface.Bypayingattention to yourwords and how you communicate, bothverballyandnonverbally,youcancreateahealthycultureofcommunications.

By applying these simple strategies you can dramaticallyincrease your odds of receiving the answer, “I’ll stay,”when others are deciding, “Should I stay or should I gonow?”

Susanne Gaddis, Ph.D., CSP,internationallyknowninterpersonal

communicationsexpertinhealthcarecommunication.Shecanbereachedatwww.

CommunicationsDoctor.com.

Elizabeth Cates, M.A.,isanOrganizationDevelopment

SpecialistinTexas,includinghealthcare,education,

government,andtransportation.Shecanbereachedatelizabeth.

[email protected].

Should I Stay or Do I Go Now: Eight Ways to Increase Loyalty and Retention

Elizabeth Cates

Susanne Gaddis

Beautiful NH camp serving inner-city and

low-income boys seeks LPN or RN from 6/19-8/22.

Responsibilities: health care, meds,

first aid for 60 campers, 25 staff. Minutes from MD/

hospital. Supportive environment.

Private accommodations, meals, children’s tuition, salary all

included.

Contact Amy Willey at 603-924-3542.

www.brantwood.org

Looking for RNsSummer camp for children & adults with disabilities.

Dates are from June 14th to August 28th.

Please contact Mary Constance for further information.Camp Allen

56 Camp Rd., Bedford, NH 03110603-622-8471 www.campallennh.org

Email: [email protected]

CAMP NURSES NEEDED!!


savE thEsE datEs!


in Boston, Mass., until December 1950. Margaret wasrecalled fromArmyReserves to service in January 1951and was stationed at Valley Forge Army Hospital inPennsylvaniaandWestPointArmyHospitalinNewYorkuntil1954whenshewassentbackoverseastoserveintheEuropean Theatre inWurzburg, Germany for two years.She returned to stateside duty at Fort Ord in Californiafrom 1956-1958 and FortDix inNew Jersey from 1958-1960. She was the first woman in New Hampshire toreceivealifemembershiptotheVeteransofForeignWars.

OR Nurse BenefactorMuriel Devens Bond, 89, died at home on October 4,2008. Muriel graduated from a Rhode Island Hospitalnursing school in 1939 andmoved into the nurses’ homeassociated with Huggins Hospital in Wolfeboro. ShepracticedasanORnurseatHugginsand later inBoston.After returned to New Hampshire, she became veryinvolved with the VNA Hospice of Southern CarrollCounty. Before her death she created a scholarship fundthrough the New Hampshire Charitable Foundation forresidentsofWakefield,BrookfieldandWolfeborowhoareinterestedinprofessionaleducationinthehealthcarefield.

Manchester NativeKevin S. Wilkinson,49,diedOctober1,2008 inMaine.He was a lifelong resident of Manchester and attendedClaremont Community Technical College, graduating in1998,withhisAssociatesDegreeinSciencewithamajorinNursing.Mr.Wilkinsonwas employed as a registerednurse,workingforPremierMedicalStaffing.

Second Career NurseKatherine Joan Patterson, 51,of Manchester, died September9, 2008 at the Concord VNAHospice House after a longand courageous battle withcancer.After being a successfulbusiness woman, at age 40 sheenrolledattheUniversityofNewHampshireandin2000earnedaB.S. degreewithhighhonors inNursing. After graduation, shewasemployedatExeterHospitaland most recently at WebsterStreet Internal Medicine. Shewas extremely proud of herprofession; a skilled nurse, leader and mentor, and acompassionatecaregivertoherpatients.

Cadet Nurse CorpsElizabeth "Betty" [Perry] Conley, 83, died Sept. 1,2008, at Hanover Hill Healthcare Center. She graduatedfromtheCadetNursesProgramduringWorldWarIIandwas amember of theU.S.CadetNursesCorps. ShewasaManchester resident since 1970where she practiced inlongtermcare.

American Nurse IconFlorence Wald, who is credited with founding hospicecare in America, died at her home in Connecticut, onNovember8, 2008 at age91.Waldwasdeanof theYaleUniversitySchool ofNursing from1959 to 1965, leavingthat post to work with Cicely Saunders from SaintChristopher'sHospiceinLondon.WhenWaldreturnedtoNewHaven,Conn.,sheorganizedaninterdisciplinaryteamfromYaletodoresearchabouttheneedsofterminallyillpatientsandsubsequentlyopenedthefirstU.S.hospicein1971. Today, there are 4,700 hospices nationwide. Wald,RN,MSN, FAAN, received a Founders Award from theNational Hospice Association, a Distinguished WomanofConnecticutAward from the governor ofConnecticut,fellowship in the American Academy of Nursing, andthree honorary doctoral degrees. She was inducted intotheAmericanNursesAssociation'sHallofFamein1996.WaldcontinuedworkingduringthelastdecadeofherlifetobringhospicecaretoprisonsintheUnitedStates

Nurse MidwifeMary Susan Kania, 60, formerly of Salem, N.H., diedOct. 19, 2008, at Bethesda Memorial Hospital, BoyntonBeach. She graduated from Mary Hitchcock HospitalSchool of Nursing and summa cum laude from theUniversity ofNewHampshirewith a bachelor of sciencein nursing. She was a member of Sigma Theta Tau EtaIota. She received amaster of science degree in nursingat CaseWestern University and graduated from FrontierSchool of Midwifery and Family Nursing. Mary wasa member of the College of Nurse Midwives and was

previously employed at Lawrence General Hospital, BonSecoursHospitalandBrighamandWomen'sHospital.Shewas recently employed as a nurse midwife at BethesdaMemorialHospitalinBoyntonBeach.

Distinguished Army NurseEleanor E. [Sweatt] Beaton died November 5, 2008 ather home in Claremont. A registered nurse for 45 yearsshe served in the USArmy inWW II earning the rankof lieutenant and serving in the Philippines. After beinghonorably discharged she practiced at Mary HitchcockHospitalandValleyRegionalHospitaluntilsheretiredin1986.

Lactation ConsultantLouise D. [Sullivan] Kuslaka,65,ofChester,NH,diedOctober12, 2008 in Hooksett. Louisegraduated from Notre DameSchoolofNursing.Shepracticedat bothCatholicMedicalCenterand Elliot Hospital, where sheretired as a labor, delivery andmaternity nurse and specializedasalactationconsultant.

First Woman to Receive VFW Award

Margaret [Coney] Greenlaw,age 90, passed away onWednesday, Nov. 12, 2008 inLittleton.AttendingUNHbeforethe War she entered the U.S.Army ANC in March of 1942,serving in Casablanca, NorthAfrica, and Italy for 33 monthsduring World War II, earningtherankofMajor.Sheleftactivemilitary service in February1946 and worked for TrygveGunderson, Ophthalmologist

Louise Kuslaka

Margaret Greenlaw

Katherine Patterson

In mEmorIam


Skin Color, Not Race, Plays Larger

Role in Injury Detection

(Philadelphia)—Femalevictimsofsexualassaultwithdarkskin are less likely than females with light skin to havetheir injuries identified,documented,and treated, leavingthem disadvantaged in both the healthcare and criminaljusticesystem,according toanewstudypublished in theNovember issue ofThe American Journal of Emergency Medicine.

According to the National Crime Victimization Survey,black women have higher rape/sexual assault cases thanwhitewomen,andoneofthemainreasonswomendonotreport sexual victimization is "lack of [physical] proof"thatanincidentoccurred.

"This finding is novel and important with respect bothto clinical assessment and the decisionsmadewithin thecriminal justice process," said Penn Nursing professorMarilynSommers,PhD,RN, theprincipal investigatorofthestudy.

Dr. Sommers' study, in which 120 black and whitevolunteers underwent a forensic examination afterconsensualsexualintercourse,found:• 55percentofthesamplesufferedatleastone,post-sex

externalgenitalinjury(suchasatear,abrasion,redness,or swelling),with injuries identified 68 percent of thetime inwhitewomen but only 43 percent of the timein black women. Significant disparities were onlyevidentforexternalgenitalia(asopposedtotheinternalgenitaliaoranus).

• Nearlythreetimesthenumberofinjuriestotheexternalgenitaliawereidentifiedinwhitewomen.

• Theeffectsofrace/ethnicityoninjurydetectionbecameinsignificant when skin color values were added to amodelthatpredictstheoccurrenceofexternalgenitaliainjury,demonstratingthespuriousrelationshipbetweenrace/ethnicityandinjuryprevalence.

"The novel findings from this study have clinicalramificationsfor thoseperformingforensicsexualassaultexams,"saidDr.Sommers."Practitionersneedtoincreasetheir vigilance when examining individuals with darkskin to ensure all injuries are identified, treated, anddocumented."

ArtikaRangan,M.S.Ed.AssociateDirectorofCommunicationsUniversityofPennsylvaniaSchoolofNursing

Nurse’sWeekisheldduringthemonthofMay,asatributeto Florence Nightingale and corresponds with her birthdate,May12.Thisweekwasoriginallydesignedtohonornursesfortheireffortsinpromotinghealthandwellnessinadditiontocaringfortheacuteandchronicallyill.Asthisisdeservingofgreatmerit,Iposeanotherviewpointastothe celebration of theworkwhich nurses are engaged indaybydayandhourbyhour.

It seems tome, that aswe look back into theworks andwords of Florence Nightingale, it is our duty to teachothersaboutpropernursingandtoengageeverycitizeninunderstandingthebasicessentialsofgoodhealth.Itiswiththis thought inmind, that I encourageyou to rethink thewaysinwhichwecanpromotenurse’sweek2009.

Thethemethisyearisquiteaproposforthe21stcentury:“Nurses—Building a Healthy America.” We may askourselves“howcan thisbeachievedsinceourpopulationin theUS is sodiverseandspreadout?”Theanswercanbegin with a formal celebratory week in May when allnursesareunifiedinthisveryimportantbattle.

Once again, we can refer to the words and ideas ofFlorenceNightingaleassheprepareshernoteson theartofnursinginthe1800’s.Asshelookstowardsthesickanddying, she realizes thatprevention is thecure.Herwordsareasapplicable today, as theywereover200yearsago.Shestatesthattheveryelementsofwhatconstitutesgoodnursingareaslittleunderstoodforthewellasforthesick.Thesamelawsofhealthorofnursingfortheyareinrealitythesame,obtainamongthewellasamongthesick.Thesewords hold asmuch strength for every aspect of nursingbothinthehospital,clinicorhomesetting.Itisourdutyasnursestopromotehealthandwellbeingbeginningwiththeveryyoung.

During her lifetime, Nightingale promoted a healthylifestyle. She stated that there are five essential points insecuring the health of ones homes; pure air, pure water,efficient drainage, cleanliness and light. Today we canmake thesesamepointsandperhaps,as fit for the times,state, proper nourishment, exercise, preventative care,healthymind,andpropereducation.BasedonthesetenetswecanbegintoexplorethemanyactivitieswhichcanbeadoptedbythevariousnursesduringtheupcomingNurse’sWeek.

First and foremost, educationmust beginwith the youngand I would venture to say, that we start in elementaryschool with simple art work promoting nursing. Youngchildrencanbeaskedtodepictanurseaspartofacontestandthevariousnursingdepartmentsofareahospitalsandcliniccanbe the judgesandawardnominalprizes to theindividualsandtotheclasses.Uponreceiptoftheseprizes,area nursewill have the opportunity to address the classforashortperiodoftimefocusingontheroleofthenurseaswellaschoosingahealthpromotion topic.Thisservestwopurposes,onebeingthepromulgationoftheprofessionof nursing and the other being an education regardinghealthyliving.

Forschool-agedchildren,Iwouldsuggestanothercontestin conjunction with either a science class or a physical

education class. After discussion with the school’sfaculty, a topic could be decided upon, perhaps healthyeatingwhereasthestudentskeeptrackoftheirdailyfoodhabits andprizesaregiven to thosewhoare successfullyin eliminating junk food from their diet. It can either beindividuals or classes. Instead of a pizza party, give ahealthy eating party filled with fruits and vegetables,eventortillasandsalsawouldbeacceptable.Thisthoughtprocess can be brought forth through high school withtheprizesandpromotionbeingageadjusted. Inaddition,clinics could be scheduledwith the dept of public healthto assure proper vaccinations are in place or certainscreeningstakeplace.

For the adult population, various hospitals and clinicscould hold screenings, i.e.: blood pressure, cholesterol,blood sugars, etc. Education regarding multiple commondiseasestatescanbemadeavailable,stroke,heartdisease,canceretc.

Healthy weight can also be promoted. This can occurat places ofwork, housing centers etc. The nurse can bethecentral figureforallof this.Ofcourse thisdoes takesometimeandplanningbutlookingatthelargenumberofnursesinanycommunity,thisiscertainlydoable.Ifeverynursetouchesoneperson,weareasuccess.

Letusnotforget thehealthymind.Relaxationtechniquesincludingyoga,classicalmusic,reading,etc.,canbeaddedtothelistofpotentialideasforallages.

It isalsopossiblefor localTVtodepictnursingandhowthe profession has made a difference in the life of thecommunity.Thelocalmedia—bothradioandprint—mayalsobewillingtospotlightnursing.Iwouldencourageallnurse leaders to utilize the opportunities set forth as wepromote our profession. In addition, I would engage theschoolsofnursingtostandstrongwiththevariousclinicalinstitutions and take part in the various activities. Thiscanonlyenhancetheireducationbyencouragingthemtobeapartoftheircommunity.Perhaps,theycanalsoholdnurse’s days at their respective institutions and call uponlocalschools tohave theirstudentsattendadayofhandsoneducation.

Honoring nurses does not always mean giving themt-shirts, parties, ice cream or any other trinket. Honormeanstoshowrespect,reverence,deference.Whatgreaterway to give homage to such a notable profession as todepictandactuponwhatweasnursesaremostproudofmainly,thecareofthesickandthewellandthecontinuouspromotionofhealth living. It is throughallofoureffortsthatwecanbeapartof“Building a Healthy America.”

MarieSullivanRN,CRRN,MSNVP,PatientCareServicesNortheastRehabilitationHospital

Thoughts on National Nurses Week

CLINICAL speCIALIstInformation systems

speare Memorial Hospital is accepting applications from qualified individuals for the full-time position of Clinical Specialist in its Information Systems Department.

The Clinical Specialist works with physicians, hospital and IS staff to increase the use of systems and technology to support clinical care and the processes associated with it.

Associates Degree in nursing or other clinical area required. Bachelor’s degree preferred or combination of Associates degree in Nursing or other clinical area with bachelor’s degree in Computer Science or other related field. Three to five years of clinical experience required. One year nursing informatics experience preferred.

send resume and letter of interest to HR Department, speare Memorial Hospital

16 Hospital Road, plymouth, NH 03264e-mail [email protected]

Fax: 603-536-0022EOE


UNH Reopens Nurse Practitioner

AdmissionsTheUniversityofNewHampshireDepartmentofNursingannounced recently that applicants for the Family NursePractitioner Masters program will be accepted for Fall2009.

The Adult Nurse Practitioner track is being phased outwith only currently enrolled students participating.According to Dr. Lynette Hamlin, Department Chair,“WehavereviewedtheneedsofNewHampshirecitizensforprimarycarenurseproviders,anddeterminedthatourlimited resources are best used to prepare FNPs for thefuture.” Hamlin noted that the Department is discussingpartnering with other nurse practitioner programs toexpandtheprogramspecialties.

Stephanie Ayan RN BSN

Atsometimeduringtheircareers,mostRNscontemplatewhether or not to pursue a bachelor’s degree in nursing.The choice to return to schoolmay bemade to increasemarketability and career opportunities and ismindful ofthe need to balance work, home and money constraints.Thedecisionisnotalwaysmadeeasily,butitisoneImadethreeyearsago.

Admittedly, there are amultitudeof reasonsnot tomakethis choice. Returning to school requires a personalcommitment of time and effort. It can also be ratherexpensive if one is not fortunate enough to have a goodeducation reimbursement program atwork.There can beaplethoraoffamilyrelatedissuesincludingchildoreldercareneeds.Itmayalsobecomenecessarytohaveaflexibleworkschedulewhenclassavailabilityislimited.Andthenthere are the personal stumbling blocks, the self doubtthat occurswhenwe are facing a change in routine or anewchallenge.Negativecommentsfromunsupportiveco-workersorfamilymembersmayseriouslyundermineone’spotentialcommitmenttopursuingcontinuingeducation.

Despitewhat can appear to be insurmountable obstacles,manynursesfindawaytoreturntoschool.Thisreturntoacademics is challenging and stimulating. It provides us

Mass. College of Pharmacy

Graduates First Class

TheManchester campus ofMCPHSgraduated their firstcohort of students in December. Thirty one students,familyandfriendsaswellasfacultyattendedthepinningceremonyinManchester.TheprogramawardsaBachelorsdegreeinnursing.StudentstookclassesattheManchestercampus, with clinical experiences in Lebanon, Concord,Manchester,Exeter,NashuaandDerry.

According to Liz Bouley, nursing faculty: “Our firstcohorthasdoneverywell,and theassistance,mentoring,guidanceandsupportbyourclinicalcommunitypartnershas been a tremendous help.We are looking forward toour graduates transitioning into the role of professionalRegistered Nurse, and we sincerely wish them all thesuccesstheysorichlydeserve.”

RN to BSN, a View from the End of the Tunnel

with the opportunity to collaborate with nurses from allareas of nursing and provides us with new perspectives.It creates in us a drive to not only improve ourselves,but towork to advanceourprofession. It is an incredibleopportunity for networking and many friendships havebeenformedasstudentcolleaguesworktogetheronclassprojects.

Aspartofmyfinalnursingclass,Iwasrequiredcomplete120clinicalhoursworkingwithabaccalaureatepreparednurse. I was part of a small group that traveled toMetlakatla,AlaskawhereweworkedatandIndianHealthService clinic. This clinical experience allowed us toobserveruralnursingwithaculturalperspective.Wemetwonderful people andhadanopportunity to see someofthemostincrediblenaturalbeautyourcountryhastooffer.ItwasaonceinalifetimeexperiencethatwouldnothaveotherwiseoccurredifIwerenotinaBSNprogram.

With graduation right around the corner, I find myselfnow looking back and reflecting uponmy BSN journey.Yes therewere obstacles in theway, but theywere dealtwithandIwasabletocontinueonmyeducationpath.Andalthoughthepathwasnotalwayseasy,thefinalproductisme: a confident,well prepared baccalaureate nursemadeallthemoresweetbythefactthatIfacedtheobstaclesandreachedmygoal.

Calling all Med-Surg Nurses—

Research Study Notice

I am currently conducting a qualitative research projectto investigate nurses’ perceptionsof their commitment toholistic pain management. Interested volunteers shouldhave at least 5 years of practice experience managingpain and caring for ill adults with diagnoses other thancancer.Participationwouldinvolvetwodigitallyrecordedinterviewsonoff-dutytime(eachtakes35–40minutes)atamutually agreed upon site and time convenient for thenurse.

If you are interested in participating or learning moreabout the study, please contact Dr. Susanne Tracy at theUniversity of New Hampshire at [email protected] or byphoneat603-862-0554.Thanks!

Valley Regional Hospital is a special place to be for healthcare professionals who put their hearts into their work. As a leading community hospital dedicated to providing comprehensive, compassionate care, our highly skilled staff enjoys the heartfelt rewards of making a difference in our patients’ lives and in their careers.

Setting theGold

Standardin Community

Healthcare

Valley RegionalHospital

243 Elm StreetClaremont,NH 03743

E-mail: [email protected]: (603) 542-3403

ATTN: RNs & LPNsLOOKINGFORACHANGE?

WearenowhiringRNsorLPNswhoarelookingforachangeandwanttomakeadifferencebyinstructingourLNAclassesinDoverandManchester.Hoursandlocationsareflexible.Musthaveatleast2yearsnursingexperienceinLTCorworkingwiththechronicallyill.

If you are looking for a small company atmosphere, flexible hours and competitive wages please contact:Pat Arsenault, HR Director, LNA Health CareersPhone: 603-647-2174 Email: [email protected]


Registered nurses witness daily how a broken health caresystem endangers the health and safety of their patientsand creates overwhelming barriers to care. The so-called“system” is largely held together through the efforts ofregisterednurseswhomustconstantlyfindwaystofill thegaps in patient care, in addition to performing theirmanyexpectedduties.

Americans trust RNs to advocate for them and look outafter their interests. In annual national polling of variousprofessions that people trust, nurses are consistently inthenumberoneposition.It is timetoleveragethat trust tocampaign for guaranteed, high-quality, affordable healthcareforall.Nurseshaveauniqueperspectivetoshareanditistime,aswehavebefore,tostepuptothechallengeofreformingAmerica’shealthcaresystem.Itisanenormouslycomplex anddaunting challenge, but the current system isnolongersustainable.Wemustplungein.Thetimeisnow.

The Goal: Guaranteed, High-Quality, Affordable Health Care for All

What’s the Solution?

A national health strategy begins with the premise thathealthcareisabasichumanright.

The U.S. health care system must be restructured toguarantee high-quality, affordable health care for all. Wemust reshape the system, review priorities and reallocateresourcestotransformthecurrent“sickcare”systemintoatrue“healthcare”system.

That means more emphasis on many of the professionalservices and skills in which registered nurses specialize:prevention, screening, health education, culturalcompetency, chronic diseasemanagement, coordination ofcare, and the provision of community-based primary careby advanced practice registered nurses (APRNs), to namea few. Registered nurses are the only clinical health careprofessionaleducatedwithinaholisticframeworkthatviewstheindividual,familyandcommunityasaninterconnectedsystemthatcankeepuswellorhelpusheal.

ANA believes a single-payer system is themost desirablestructureforfinancingareformedsystem.Atthesametime,anywell-designedmechanismsorinterventionsthatimprovehealth care access, quality, equity and cost-effectivenessdeserveourattention.

There ismerit in reformplans thatwould create a public-private coverage partnership. In such partnerships, privateinsurance plans would be held to at least the same highquality standards and benefits design offered by improvedpublic plans. In the coming debate, nurses must lookthroughtheirpatients’eyes,aswellastheirown,toevaluateallhealthreformproposals.

ANA’s full health reform policy statement, ANA’s Health System Reform Agenda, is available atwww.nursingworld.org.UnderHealthCarePolicyontopmenu,clickonHealthSystem Reform. Document is located in “Resources”section.

Tune In to Health Reform

A Few Facts Nurses Should Know

ItisacommonbeliefthattheU.S.hasthe“besthealthcareintheworld.”However,itseemsmoreaccuratetostatethat“thebesthealthcareintheU.S.isthebestintheworld.”

Unfortunately, an array of indicators suggest that manypeopleintheU.S.donotreceiveitsbesthealthcare.

Let’slookatsomeofthoseindicators.

Access: Forty-seven million are uninsured in America,a figure that includes 9 million children. One in fiveAmericans—59 million people—reported not getting ordelaying needed medical care in 2007, up from one inseven—36 million people—in 2003. Strikingly, whileaccessdeteriorated forboth insuredanduninsuredpeople,itwastheinsuredpeoplewhoexperiencedalargerrelativeincreaseinaccessproblems.

Unmet medical needs have increased for low-incomechildren, reversing earlier trends and widening the accessgap between poor and higher-income children. (2008,RWJF)

Quality:The1999 Institute ofMedicine report,To Err is Human: Building a Safer Health Systemshockedthepublicandthehealthcarecommunity,reportingthatupto110,000deathsperyearinhospitalswereduetopreventablemedicalerror.Almost adecadeago, this report estimated the totalnational costsofpreventablemedical error in the rangeof$17-29billion.

The IOMhas identified sixmajor goals that can raise thequalityofhealthcare,andANAhasadoptedthosesixgoalsas part of its ownHealth System Reform Agenda. Healthcare should be: safe, effective, patient-centered, timely,efficient,andequitable.

Cost: People reporting access problems increasinglycited cost as anobstacle toneeded care, alongwith risinginsuranceratesplanout-of-pocketcosts.(2008,RWJF)

Therisingcostsofhealthcarehaveresultedinsomedeeplytroubling consequences for America’s families. Accordingto a recent report by the Commonwealth Fund, whichdrawsonfouryearsofsurveydata,41percentofworking-age Americans—or 72million people—havemedical billproblemsorarepayingoffmedicaldebt.Thisisupfrom34percent in 2005. An estimated 116million people -nearlytwo-thirdsofworkingageadults—in2007:

• hadmedicalbillproblemsordebt• wentwithoutneededcarebecauseofcost• wereuninsuredforatimeor• were insured but had high out-of-pocket medical

expensesordeductiblesrelativetoincome(thecategoryof“theunderinsured”).

Workforce: Most health reform plans claiming to becomprehensive omit the single most important featurerequired to implement the rest of it: the development anddeployment of the health care workforce. The U.S. isprojected to experience a shortage of 1million nurses by2020. Nursing does not have an adequate, stable fundingstreamtoeducate thenursesneededinthe21stcentury.Anursingfacultyshortagestymiesrecruitmentandeducation.

Retaining RNs once they have entered the workforce isanother serious problem that affects the supply of nurses,which impairs patients’ outcomes and threatens patientsafety.

Primary care has not received the needed emphasis in asystemthatpaysforprocedures,notholisticcare.Physiciansspecializinginprimarycarearediminishinginnumber,inpartbecauseof thecurrentfailure toadequatelyreimburseprimary care services; APRNs are similarly affected byinequitiesinreimbursement.Governmentandprivateforcesconverge to create barriers to APRNs as primary caregivers.

What ANA is doing?

Focus on Work Force

At the heart of ANA’s health reform advocacy is ANA’sHealth System Reform Agenda, calling for guaranteed,high-quality, affordable health care for all. Among themany groups pushing for comprehensive reform, though,ANAstandsalmostaloneinplacingtheissueofhealthcareworkforce on the table for discussion. ANA believes thatthe health careworkforce issue cross-cuts all three of the“standard” issues categories–Access, Quality & Cost–thatare used to describe the big themes of reform. If healthreform doesn’t include attention to the development anddeploymentofourhealthcareworkforce,itwillfail.

Partnering to Amplify Nursing’s Voice

ANA has partnered with a variety of coalitions seekingguaranteed, high-quality, affordable health care for all.Linking arms with other groups is an effective meansof promoting and amplifying nursing’s message andstrengtheningthenationalmomentumforchange.

Health Care First

ANA is a founding member of Health Care First, acollaborative of national organizations united in theirurgent appeal for health reform. The collaborative wasinitiated by FamiliesUSA. Other founding members arethe American Hospital Association, the Catholic HealthAssociation,SEIU, theNationalFederationofIndependentBusinesses, and the American Cancer Society, amongothers.Thecoalition’smajorworkrightnowisinurgingthepresidentialcandidatesandcandidatesfortheU.S.Congresstomake health reform a top domestic priority in the newAdministrationandCongressin2009.

In addition to a letter campaign and personal meetings,HealthCareFirst is running amulti-million dollarTVadcampaign,urgingthenewpresidentandCongresstotacklehealthreformearly.CheckoutFamiliesUSAwebinitiative,Stand Up for Health Care, which is meant to empowerordinary Americans with the knowledge and opportunitytobecomeleadersinthemovementforhealthcarereform.www.standupforhealthcare.org.

HCAN!

Health Care for America Now is a national grassrootscampaign organizing millions of Americans to win aguarantee of quality, affordable health care for all. Thegroup is grounded in organizations that can mobilizepeopleatwork,athome,intheirneighborhoods,andonline.Members include community organizers, nurses, doctors,smallbusinessowners,faith-basedgroups,organizationsofpeople of color, seniors, unions and others seeking urgentchange.

HCAN! sets out ten fundamentals for health reform,elementsconsistentwithANA’sownHealth System Reform Agendatoguaranteehigh-quality,affordablehealthcareforall.

Learn more at: http://healthcareforamericanow.org. Youcan add your own signature, and urge your organizationand Members of Congress to sign the petition at: http://healthcareforamericanow.org/site/action_center/

Herndon Alliance

ANAisalsoafoundingmemberof theHerndonAlliance,a nationwide non-partisan coalition of more than 100minority, faith, labor, advocacy, business, and healthcareproviderorganizationsseekinghealthreform.TheAlliancewasformedtoprovidepartnerorganizationsaneutralforumto build momentum among many different groups for along-term health reform movement. The unifying factoramongmembers is a commitment to seeking guaranteed,high-quality,affordablehealthcareforall.

By using surveys, polling data, focus groups, and othermethods, theAlliance seeks to expand the base of peoplesupporting affordable healthcare for all, and increase thebreadthanddepthofvoicesworkingand speakingout forhealthcarereform.Formoreinformation,andtoolsyoucanuse to convey the reform message effectively, check outwww.herndonalliance.org.

Take On the Forces Resisting Health Reform

Will Public Concern about the Economy Push Health Reform Off the Table?

Health reform must be among the top priorities of theincomingnewPresidentandCongress.Yet,withoutstrongpublicmomentum,theeagernessofanewCongressto“dosomething”abouttheU.S.economyorgaspriceswillpushhealthreformoffthetable.

Faltering job and income securitymakeworking familiesevenmorefrightenedthattheymaybeonemajorillnessoraccidentawayfromeconomiccatastrophe.

While insurance companies and drug companies spendbillions of dollars trying to influence the Congress andadministrationinthehealthcarearena,theycannotobscuretheeffectsofrisinghealthcarecosts.

hEalth rEform

Health Reform continued on page 18

Time for Nurses to Tune In, Take On, & Turn Out


Withhealthcarecomprisingover16%oftheU.S.economy,and insurance coverage costs far outpacing inflation, wesimplycannot fix theeconomywithout fixinghealthcare.Nurseshaveanobligationistohelpeducatethepublicandlawmakers about how the economy and health care areinextricablylinked.

A Word About Drug Prices

Drug companies continue to fight efforts to allow theU.S. government to negotiate drug prices, based on bulkpurchasing for the Medicare program. Medicare is theonly federalprogram thatdoesn’tnegotiatea fairprice forprescriptiondrugs.

• From2002 to 2007, prescription drug prices increasedby 50 percent, more than 2 1/2 times faster thaninflation.[AARP]

• 4 in 10 Americans report struggling to pay formedicationprescribedby their doctors. [KaiserFamilyFoundation]

• Twenty-ninepercentofAmericansgowithoutprescribedmedicationduetoitscost.[KaiserFamilyFoundation]

Estimated annual cost to the US taxpayer: If Medicarewereallowedtonegotiatewithmanufacturers,theprogramwould save approximately $90 billion a year,which couldbepassedalongtotheelderlyintheformoflowercostsorgreaterbenefits.[CenterforEconomicandPolicyResearch]

Some Misconceptions about Health Reform

Misconception: Giving government an oversight or“watchdog”roleinhealthcareisthenextstepto“socializedmedicine.”Competition in themarketplace is thebestwaytoreducecostsandimprovecare.

The Reality: The competitive marketplace is not theappropriateway tocreateanequitable,high-qualityhealthcare system for all. The inherent imbalance of knowledgeand bargaining power, combined with individuals’ needfor services in a crisis, heavily favors insurance over theworking family. Government’s role is to facilitate and sethigh standards, hold plans accountable, keep deductibleslowandbenefitsequitable.

Misconception: Health reform just needs to provideinsurance coverage for the 47millionAmericanswho arecurrentlyuninsured.Wedon’tneed to turn thehealthcaresystemupsidedowntosolvetheproblemsofaminorityofpeople.

The Reality:“It’snotjusttheuninsuredpersonwhosuffersfrom not having health coverage. When millions of ourneighborsdon’thavehealthcare,itaffectsusall…Wepaymore in insurancepremiums tooffset thecostsofcareforthose without insurance. We all suffer when emergencyroomsareoverburdenedbypeoplewithmajorillnesseswholack thehealth insurance thatwouldhavehelped themgetthe preventive and primary care to treat their conditions

before they requireurgentcare.Therearegraveeconomicand health consequences, not to mention serious moralconcerns,whenalmostone insixAmericansgoeswithouthealth insurance.” Risa Lavizzo-Mourey, M.D., M.B.A.,PresidentandCEO,RobertWoodJohnsonFoundation

Misconception: Peoplewill buy health care servicesmorejudiciously and sparinglywhen forced to pay a significantportion of the bill… when they have some “skin in thegame.”Thisis thetheorybehindHealthSavingsAccounts(HSAs).

TheReality:ArecentCommonwealthFundsurveyconfirmsearlier studies demonstrating that this approach is hurtingAmericans’ health status. Many families are postponingor foregoing treatment,due tohighdeductiblesorco-pays.Manyputoffseeingtheirhealthcareprofessionalwhenill,andfailtofillprescriptionsorskiporderedtests,treatmentsand preventive care. About half of those surveyed haddifficultypayingtheirhealthcarebills;manytookoutloansand/ormortgages,orincurredcreditcarddebttopaythem.

Spreading the Word: What Can Nurses Do…?

• Talktocolleagues,patientsandfriendsabouttheeffectsofthebrokenhealthcaresystemonyourpatientsandthecareyoutrytoprovidethemeachday.

• Attend professional and educational meetings to learnandshareinformation.

• Join a professional association and help amplify thepowerfulvoicesofNursing.

• Bevisibleandvocalontheneedforhealthreform.• Tell your story in a letter to the editor of your local

paper.

Questions Nurses Should Ask About Any Health Reform Proposal

1. Isitatrulyinclusivesystemwherenooneisleftout?2. Doesitimprovepeople’saccesstohealthcare?3. Doesitreallocateresourcesandinfrastructuretosupport

primarycareandprevention?4. Doesitrelyonevidence-basedcareandrewardquality?5. Does it tackle disparities in health care quality and

outcomes,especiallyamongvulnerablepopulations?6. Is it affordable for working families? Does it protect

families fromfinancial ruin incaseswherehealthcareexpensesaredisproportionatelylarge?

7. Does it offer affordable and predictable costs tobusinessesandemployers?

8. Doesitdemandaccountability,transparencyandequityfromtheprivatehealthcaremarketplace?Doesitinvestinnursing?

9. Does itopen thedoor forRNs tooptimize their skills,knowledgeandabilities inallrolesandsettingstohelppatients?

10.Does it provide a coherent national health care visionandstrategy?

And perhaps most important for registered nurses: How will this affect my patients?

Reprintedfrom“TheAmericanNurse”,anANApublication

Health Reform continued from page 17

When your loved one is hospitalized, you quickly learn to recognize who’s there to help

and who’s not.

by Marci Crestani November 2008

Overthelasttwoyears,Ihavespentasignificantamountof time in hospitals in L.A. and Chicago because ofmedical crises with various members of my extendedfamily. And no matter how well- or little-known thesehospitalsare,onefactremainsthesameacrosstheboard:Youknowagoodnurse theminuteshe/hewalks into theroom.

Good nurses in a hospital make me weak in the knees.For starters, they smile at their patientswith the implicitunderstanding thatyouaremembersof thesamespecies.Goodnursesgreettheirpatientsbynameandlookthemintheeyewhen theyask, “Howareyoudoing?”They thenrespondtotheirpatients’answersasiftheyactuallyheardthem.Goodnursespossessanairofconfidencethatdoesnotrefertopower.

Unfortunately,justastherearebadpatients,therearealsobadnurses.Badnursesarelikeoverworkedandunderpaidbaggage handlers -- with your familymember being thesuitcase.IdescendtoaDarwinian“survivalofthefittest”levelofstrategywhenIencounterabadnurse.

I once said to a bad nurse, “Oh,wow! I really like yourclogs!”andthendescribedindetailwhyherclogsweresocool--eventhoughIthinkclogslooklikesomethingthatshouldbeworninprisonyards.Butmydadneededapainpillandthisgalneededyetanotherpushtogivehimone.Herclogsweremywayin.Worseyet,itworked.

Nosuchluck,though,withtheSuperBadnurses.Theytoooperateat aDarwinian level and theycan smellmy fear.Theirmessage back tome, laser beamed from their eyesdirectlyintomine,is,“I’montoyou,honey,andyouractain’tworkingwithme.”

Undaunted,I’llask,“So,doyouhaveanykids?”

What differentiates good nurses from bad ones are thepersonal qualities they possess before they even entera nursing program. Are they smart, careful, observant,precise, compassionate?Theseareattributes that can’tbetaught.Most important, though:Do theyhave a first-rateshort-termmemory?

Nurses need short-term memories with stratosphericstorage capacity. They are continually interrupted bypatients, family members and other staff with questionsand requests. I can’t even remember if I’ve taken mycalcium pill for the day, so I’d hate to be trusted withremembering whether or not I gave someone morphine.“Well,IthinkIdid”isnotthezoneyouwantanursetobeoperating in.Anurse’smemory is vital in the dictionarysenseoftheword.

With good nurses you have a trust and rapport that istranscendent. They take the lead with the patient. Theirnursing education is a launching pad not just for theircareer,butfortheirpassion.

(Andby theway, if I flatteragoodnurse,webothknowit’ssincere.)

Originally published in the LA Times–Reprinted with theauthor’spermission.

Nurses: The Good, the Bad and

the Difference Between Them

REGISTERED NURSES & NURSE PRACTITIONERSNEW HAMPSHIRE HOSPITAL

State Facility Serving the Acute Psychiatric Needs of Children,Adolescents and Adults

With a demonstrated commitment to values of compassion, integrity, collaboration, and communication, NHH Joint Commission-accredited and Dartmouth-affiliated acute care teaching hospital

NEW HAMPSHIRE DEPARTMENT OF HEALTH AND HUMAN SERVICESConcord NH

Salary commensurate with nursing experience & ANCC certification

Psychiatric Nurse PractitionersGet off the “20 minute billable” treadmill and stop spending your weekends on call. Instead, practice within the full scope of the ARNP role in an environment where the “bottom line” is excellence in patient care!

Psychiatric Nurses RN I,II,III. The state’s premium inpatient psychiatric facility, past winner of the NHNA “Supportive Nursing Environment Award” seeks competent, caring and motivated nurses to join its clinical team. ANCC or other national certification required for RNIII.

New Grads The flexible residency program supports your transition to the role of nurse leader. IF YOU ARE LOOKING FOR: Supportive clinical environment, professional growth opportunities, dynamic milieu, comprehensive orientation program, outstanding benefit package including health and dental insurances contact: Human Resources at (603) 271-5855.

To apply, obtain an application from Human Resources at the Dept. of Health and Human Services, New Hampshire Hospital, 36 Clinton St., Concord, NH 03301, (603) 271-5855. An application may be downloaded from the Division of Personnel website at http://www.nh.gov/hr, and mailed to the above address.

Please include copy of college transcripts and note shift preference (if relevant)on completed application. Employees will be required to pay an agency/union fee.

The State of New Hampshire is an EOE.

JOIN NHNA TODAY!


Nurses Voted Most Trusted Profession

SILVER SPRING, MD—For the seventh consecutiveyear, nurses were voted the most trusted profession inAmericainGallup'sannualsurveyofprofessionsfortheirhonesty and ethical standards. Eighty-four percent ofAmericans believe nurses’ honesty and ethical standardsareeither "high"or"veryhigh."

“It’s a proud day for nurses and for nursing,” remarkedANA President Rebecca M. Patton, MSN, RN, CNOR.“The fundamental principles of nursing are compassionand respect for the individual patient. They are whatinspire each nurse to strive to promote health, preventillness and alleviate suffering. It’s gratifying to see thoseprinciplesrecognizedbythepublicweserve.”

Since being included in the Gallup poll in 1999, nurseshave received the highest ranking every year except in2001, when fire fighters received top honors. Resultswerebasedontelephoneinterviewswithmorethan1,000adults.

Hi. I’mPattyWooten, anurse—first and foremost. I am also ahumorist, a clown and a leaderin the therapeutic laughtercommunity.For the last 25 years, I’ve hadthe opportunity to share withthousands of nurses around theworld who validate my personalobservations: opportunity forlaughter is abundant and alsoessential for both the nurse andthepatient.

IamhonoredtobeyourNurseWeek2009celebrityspeakerfortheNHNA“LaughandLearn”day—Monday,May4th.In the afternoon I will teach a 3 hour workshop entitled“FindingComedyinChaos”(earnCEcontacthoursasyoulaugh).Wewill discuss the scientific evidence behind thetherapeutic benefits of humor and laughter and together,we will develop strategies to bring more laughter to ourown lives and also for our patients. During the eveningcelebrationwewillcontinueourlaughterandlearningasIweave important concepts into a stand-up comedy routineansweringthequestion:“What’ssoFunnyaboutNursing?”This program is guaranteed to help you laugh until yourcheekshurtandtearsrundownyourleg.

Topiqueyourinterest,thearticlebelowandoneinthenextissue,willgiveyouapreviewofsomeofthetopicswewillexplore. I look forward to laughing togetherwithyounextMay!

••••

Got Stress?If we want to reduce the unhealthy impact of stress, weshould make opportunities for more humor, laughter andplay. Our sense of humor gives us an ability to find theabsurdityinanysituation.

Some people see absurdity quite easily, for instance myco-workerSally. Itwas6:40amonour telemetryunitandnurseswerebeginning togatherat the station.Oneofour“confusedandyelling”patientswasplacedinaroomnearthenursingstation forhissafety.AsSallywalkedpasthisdoorway,thepatientbegantoyellandscream.Sallylookedoveratallofus, rolledhereyesandstated“Well, todayisgoing to be a Xanax kind of day.” We all laughed. Welaughed in recognitionofhowfrustrating itcanbe tocareforapatientinthiscondition.Weallwereallonexactlythesamewavelengthinthatmomentofsharedlaughter.Itisthisshared laughter that lifts the team spirit and creates unitythroughthebondthatonlylaughtercanbring.

Why Nurses Need HumorIamremindedofapoemwrittenbycriticalcarenurseswhorealized the importance of laughter and play, but noticedthatmany patients and visitorswere confused or upset byhearing this in such a serious place. To help the visitorsunderstand,theyplacedacopyofthispoeminthewaitingroom.

Ifyouarewaiting....Youmaypossiblyseeuslaughing;oreventakenoteofsomejest;

Knowthatwearegivingyoulovedoneourcareatitsverybest!

Therearetimeswhentensionishighest;Therearetimeswhenoursystemsarestressed;

We'vediscoveredhumorafactor,inkeepingoursanityblessed.So,ifyou'reapatientinwaiting,

orarelativeorfriendofoneseeing,Don'tholdoursmilingagainstus,

it'sawaythatwekeepfromscreaming.

Our ability to laughand find the funny sideof a situationhelps us to maintain our balance and perspective duringstressful times. As psychologist Moshe Waldoks stated,“Asenseofhumorcanhelpyouoverlook theunattractive,toleratetheunpleasant,copewiththeunexpectedandsmilethrough theunbearable.”Our senseof humorgives us theabilitytofinddelightandexperiencejoyevenwhenfacingadversity.

One of the earliest and most extensive studies of humorand its use by health professionals was compiled in theearly 1970s by nurse-educator Vera Robinson as part ofher doctoral thesis. First published in 1977, herworkwasupdatedandreleasedagainin1991.Today,almost30yearslater, it continues to be one of the most comprehensivestudiesofhumoranditsimportanceinnursingpractice.

Humor, Laughter and MirthHumor, laughter,and theresultingemotion,mirth,nourishthe body, mind, and spirit. Humor is a cognitive abilityengagingthemind.Laughterisaphysicalactivityactivatingthe body. Mirth is an emotional experience that lifts thespirit.

Why does humor exist? One of the main reasons humorexistsmay be that it helps people adapt to the stresses intheirlives.Asapioneerstressresearcher,HansSelyenoted,“Stress is not the event, but rather our perception of theevent.”Inotherwords,itispeople’sinterpretationofeventsthatcausesstress,nottheeventsthemselves.Andasenseofhumorhelpspeopletoviewdifficultcircumstancesinalessstressfulway.

Styles of HumorDifferentstylesofhumorserveusindifferentways.Hopinghumoraccepts thesituationandlaughsanyway.Itgivesuscourage to face challenges. Coping humor laughs at thesituation. It gives us a release for physical and emotionaltension. Groping humor laughs in spite of the situation.It protects the caregiver from the emotional impact ofwitnessing tragedy, suffering and death on a daily basis.Here are some examples of hoping, coping and gropinghumor.

Hoping humorHowYouKnowIt’sGoingToBeaLongShift

• Youstepofftheelevatorandemergencyroomgurneysarelinedupinthehall.

• Thecrashcartisnotinitsusuallocation.• Therearetoomanypeopleinthenursingstation.• Thereisnobodyinthenursingstation.• Housekeepingisscrubbingalargeareaofthefloor.• Yougettwoadmissionsduringreport.

Coping HumorNursesoftencreatehumor tohelp themreleasefeelingsofhostility or frustration by making jokes about physicians.I’msurethatphysiciansdothesame.

WhatdoyoucalltwoorthopedicsurgeonsreadinganEKG?Adouble-blindstudy.

How is aneurosurgeon just likea sperm?One in200,000becomesahuman.

What does itmeanwhen a physicianwritesWNL on theHistoryandPhysical?WeNeverLooked.

Groping HumorSometimes, caring for patients who are noncompliant,combative, demanding, or ungrateful can be frustrating.Thesepatientsaresometimesreferredtoasa“gomer”—anacronym created by Samuel ShemMD writing about hisinternshipexperience.GOMERisanacronymforGetOutofMyEmergencyRoom.Over the years, several versionsandadditionstothegomercriterialisthaveevolved.Youknowyourpatientisagomerwhen:

• hisoldchartweighsmorethan5pounds.• hispreviousaddresswastheVAhospital.• he keeps tying his pajama strings inwith the Foley

catheter.• hecanhaveaseizureandneverdrophiscigarette.• heasksforacigaretteinthemiddleofhispulmonary

functiontest.• hisB.U.N.ishigherthanhisIQ.

Itisimportanttonotethatgropinghumor,sotherapeuticforstaff,maynotbeappreciatedbyclientsortheirfamilies.

Ho Ho Holistic HealthHumor,laughter,andplaycontributetoourhealthandwell-beinginmanyways.Eachtouchesourbody-mind-spirit initsownway.Humor,asacognitiveprocess, isprimarilyamentalactivity.Thebehaviorof laughteraffects thewholebody,fromcellstoentireorgansystems.Playandaplayfulspiritfilluswithjoy;connectsuswithothers,andkeepusfocusedon thepresentmoment.Eachof thesecanhelpusimproveourabilitytocopewithstress.

Jestfullyyours,PattyWootenwww.jesthealth.com

Patty Wooten

Laughter—The Perfect Antidote for Stress

TUFTS UNIVERSITYSCHOOL OF MEDICINE

Master of science in Pain research, education

and Policy

andcertificate of advanced

study in Pain toPics

Setting the Standard for Pain Education

CONTACT:

[email protected]

CALL:

617-636-3640

Tuftswww.tufts.edu/med/prep


by Susan Trossman, RN

Sticks and stones may break my bones, but names will never hurt me.

Downplayingtheeffectsofverbalabusehasbeenthewayof the world for decades in both the schoolyard and theworkplace.Butthingsarechanging;TheJointCommissionrecently issued a “sentinel event alert” that’s aimed atstopping rude and disruptive behavior among health careprofessionals.

“Intimidation and acting out behavior creates a high-stress environment that’s incompatible with the cultureof safety that we’re trying to promote in health care,”said Grena Porto, MS, RN, ARM, CPHRM, a patientsafety and risk management consultant who serves onThe Joint Commission’s Sentinel Event Advisory Group,which issued the alert. “It’s behavior that’s not limitedto one group, and it’s been tolerated within health careorganizationsfortoolong.

“Oneoftheunderlyingdriversisstress,partiallybecausewehaveastaffingshortage.Sopeoplealreadycomehomefeeling like they’vegoneseveral rounds inaboxing ring.Wedon’tneedtoaddtoitbyallowingthesebehaviors.”

Long time coming

In promoting the alert, the Joint Commission notedthat rude language and disruptive behavior are not justunpleasant for health care professionals who may be onthe receiving end, but they also pose a serious threat topatient safety and the overall quality of care. The JointCommission issuesanalert to identifya specific sentinel(potentially harmful) event, describes its commonunderlying causes and recommends ways to preventoccurrencesinthefuture.

The JointCommission also is introducing new standardsrequiring more than 15,000 accredited health careorganizations to create a code of conduct that definesacceptable and unacceptable behaviors and to establish aformal process formanaging unacceptable behavior. Thenewstandards takeeffectJan.1,2009andaffecta rangeoforganizations,fromhospitalstohomehealthagenciestolaboratories.

“Most health care workers do their jobs with care,compassion and professionalism,” Joint CommissionPresident Mark Chassin, MD, MPP, MPH, said in astatement. “But sometimes professionalism breaks downand caregivers engage in behaviors that threaten patientsafety.Itisimportantfororganizationstotakeastandbyclearly identifyingsuchbehaviorsandrefusing to toleratethem.”

Since it came out, nurses who have been exploring theissue for several years say thatmuchof thepress aroundthe alert has focused on bad behavior on the part ofphysicians.

Porto, founder and principal of QRS HealthcareConsulting, LLC, explained that studies have shownthat physicianswho act out have amore profound effect,becauseoftheirrelativepower.

There also have been several celebrated cases reportedin themediaofphysicianshaving temper tantrums.Casein point: In August, the Boston Globe wrote about anorthopedicsurgeonwhothrewapairofscissorsintheOR,narrowlymissinganurse.

Many nurses can speak to their reluctance to phonecertainphysiciansforfearofincurringtheirwrath.Nursesexploringworkplacebullying,however,saytheircolleaguesmust look beyond the nurse-physician relationship whendeveloping and implementing the new Joint Commissionstandardsandalertrecommendations.

“When I heard about the Joint Commission alert, I wasabsolutelythrilledandfelt itwaslongoverdue,”saidCol.JohnMurray, PhD, RN, CPNP, CS, FAAN, president oftheFederalNursesAssociation(FedNA).In2006,FedNAsuccessfullygainedsupportfromnurseleadersnationwidefor a resolution introduced atANA’sHouse ofDelegates

andaimedat stoppingunhealthyworkbehaviors, suchasbullying,hostility,lateral(peer-to-peer)abuse,intimidationandabuseofauthority.

FedNA introduced the HOD resolution because nursemembers recognized bad workplace behaviors as anescalatingproblemoccurring inall settingswherenursespractice, learn, teach, research and lead–and in hospitalsand academic institutions, large and small, rural andurban.

Murray frequently speaks on workplace bullyingthroughout the United States and beyond. And whennurses who’ve been in abusive situations approach himafterward, none describe their perpetrators as physicians.Instead, they generally mention nurse leaders, such asnurse managers and executives. Also nurses who reportproblemsmaynotbetakenseriously.

Ramon Lavandero, MSN, MA, RN, FAAN, director ofCommunicationsandStrategicAlliancesfortheAmericanAssociationofCritical-CareNurses(AACN)hasseenthelackof follow throughon reportsofabuseandhopes theJoint Commission alertwill serve as a galvanizing forceforworkplacechange.

In 2006, AACN co-conducted a workplace survey ofsome4,000 critical care nurses,who averaged17.5 yearsof experience.Sixty-fivepercent reportedexperiencingatleastone incidentofverbalabuse in thepastyear fromaphysician (themost common), nursemanager, other RN,patient or other person. Although 47 percent said theirfacilityhadzerotolerancepoliciesinplaceoutlawingthistypeofabuse,onlyone in fournurses reported that theirfacilitieswerefullycommittedtoenforcingthem.

On the case

A developmental pediatric nurse practitioner, JudithVessey,PhD,CRNP,MBA,FAAN,begandelvingintotheworld of teasing andbullying in relation to its effects onchildren.TheBostonCollegenursingprofessor has sincebeenengaginginaseriesofstudiesonnursesandbullyingwith an eye toward developing effective interventions toensureabetterworkplace.

Inoneofhermorerecentprojects,Vesseyandcolleaguescreated an online, 30-question, nationwide survey tocapture a snapshot of the experiences of RNs, includingstaffnurses,educatorsandadministrators.Thesurveyalsoincluded an open-ended question that allowed nurses toexpandfreelyonbullyingintheworkplace.

She defines bullying specifically as something that isrepetitive, has a real or perceived power differentialbetween the person doing the bullying and the targetedperson, and has an intent to harm. (Lateral or horizontalabusetakesoutthepowerdifferential,butstillisdesignedto cause upset. Harassment has many of the samequalities of lateral abuse, but is coveredby a set of legalprotections.)

“At the time, we didn’t think we’d get many responsesto the open-ended question, but two thirds of thenurses responded and wrote paragraphs and even pagesdescribingtheirexperiences,”saidVessey,aMassachusettsAssociation of RegisteredNursesmember. “Many of thenursestalkedaboutlateralviolenceorharassment.Intheirminds,it’sallthesame.”

Through their research, they discovered that nurse-to-nurse bullying is a major problem in need of evidence-based interventions. She added that individuals who aremostat risk forbeingbulliedare thosewhoaredifferentfromthegroup,suchasnewnurses, floatnursesor thoseofadifferentrace,ethnicityorgender.

The fact that nursing is a traditionally female professionthatexistsintraditionallyhierarchalenvironmentsdoesn’thelp.

“Whenbullyingothers,boyshavetendedtousefisticuffs,andgirlshaveusedsocialtoxicity[forexample,ostracismormanipulationthroughgossipingandrumor-spreading],”Vessey said. “And if social toxicity worked for them insixthgrade,itmayworkforthemontheunit.”

Through his interactionswith nurses,Murray said that aprimefactorbehindhealthcareprofessionalsparticipatinginrude,condescendingorotherabusivebehaviorseemstobe more about personality type than just working understressfulconditions.

Dianne Felblinger, EdD, MSN, WHNP-BC, CNS,RN, believes incivility is far more prevalent in nurses’workplaces thanactualbullying.Shedefines incivilityasa behavior of low intensity, of ambiguous intent to harmandinviolationofworkplacenorms.Itincludesbehaviorssuch as refusing to work collaboratively, gossiping andemotionaltirades.

“Civility matters, and it needs to be part of orientationandannualcontinuingeducationprograms, likeCPRandbloodbornepathogens,” saidFelblinger,alsoanexpertoninappropriateworkplace behaviors and a professor at theUniversityofCincinnati’sCollegeofNursing.

However,shenotedthatwhenbullyingoccurs,thetargetsofabusewaitanaverageof22monthsbeforetheyreportit.Nursesandotherswhoarebulliedcanexperienceagreatdeal of anxiety and depression, aswell as post-traumaticstressdisorderandphysicalproblems.

Andthenthereistheissueofpatientcare.

Nursingrequiresqualityteamwork,andadirectcauseandeffectofbadbehaviorsonpatientoutcomes isnotalwaysobvious,accordingtoVessey.

If nurses are dissatisfied with their jobs because of thework environment, they don’t want to go to work or befully engaged. This leads to an unstable and disengagedworkforceandultimatelypoorpatientcareconditions.

Added Felblinger, “In health care, we’ve always takena stern approach to our roles, because what we do is soserious and important. But how we treat ourselves andeachotheraretiedtopatientsafetyandqualityofcare.Sochangingtheculturewouldbevery,veryhelpfultohealthcareprofessionalsandpatients.”

Education and enforcement

AACNhas been a leader inworking to promote healthyworkplaces for RNs—devoid of bullying, condescendingbehaviors, a refusal to answer questions, angry outburstsandphysicalcontact.

In 2004, the association issued a position statementcalling for zero tolerance toward abuse. In that positionstatement, it noted than 12 percent of nursing turnoverwas directly attributed to factors associated with verbalabuse. A year later, the association produced the AACNStandards for Establishing and Sustaining HealthyWorkEnvironments, the first national standards to address keyworkplace practice components. These include the needfor nurses and other health care professionals to achieveskilledcommunication,truecollaborationandmeaningfulrecognitionofwhateachgroupbringstothetable.

ThestandardssupportprovisionsoutlinedinANA’sCodeof Ethics for Nurses and “provide a framework to assistnurses in upholding their obligation to practice in waysconsistentwithappropriateethicalbehavior,”accordingtotheAACN standards document. The document identifiescritical elements of skilled communication, for example,noting thatorganizations’policiesshouldeliminateabuseand disrespectful behaviors in the workplace. It alsorequiresfacilitiestoestablishsystemsinwhichindividualsand teams formally evaluate how communication affectsclinical,financialandworkenvironmentoutcomes.

Another standard calls for nurse leaders to embrace, aswellasauthenticallyliveandengageothersinachievingahealthyworkenvironment.Amongtheelementsneededtomeetthisstandardisonethatrequiresfacilitiestodevelopmentoring programs for all nurse leaders.Another statesthat facilities give nurse leaders the financial and humanresourcesneededtosustainahealthyworkenvironment.

Behaving Badly?Joint Commission Issues Alert Aimed at Improving

Workplace Culture, Patient Care

Behaving Badly continued on page 21


“AACN believes that maintaining a healthy workplaceis a shared responsibility between the individual and anorganization,” said Lavandero, a member of the GuamNurses Association. “An organization can establish allthe policies it wants. But if it doesn’t foster the positivedevelopment of the skills needed and individuals don’tembracethem,it’sasenselesspolicy.It’salsounethical”

Portowasinstrumentalincreatingthealertandknowsthathealthcareorganizationshavebeenreticent toadmit thattheymayhaveaworkplacecultureproblem.

“I saw this as a huge issuewhileworkingwith facilitiestoestablishacultureofsafetyandbuildteamwork,”Portosaid.“Therewasalotofdenial.Orifanursecomplained,acolleagueormanagerwouldsay,‘Ohgrowup—sohe’sajerk.Justdoyourjob.’”

Sheadded thatnursing supervisorsoftenenabledabusivebehaviorbyassumingarefereeroleandnotafocusingonstoppingtheabuse—particularlywhenitcametoworkingrelationshipswithphysicians.

“None of the professions have taught their students howto talkwithsomeonewhogetsoutofcontrol,orhownotto get out of control themselves,” Porto said. “Trainingand education are important, but that doesn’t change thebehaviorbyitself.Youneedzerotolerance,andithastobeenforced.That’swhatiscalledforinthealert.

“Anddiscipline isanappropriate response to this typeofbehavior,”shecontended.“IfsomebodythrowsaknifeatyouintheOR,itshouldn’tbea‘let’sgogetacupofcoffeeandtalkaboutthis’response.”

Tohelpputanendtointimidatinganddisruptivebehaviorsamong physicians, nurses, pharmacists, therapists,support staff and administrators, the sentinel event alertrecommendsthathealthcareorganizationstake11specificsteps,includingthefollowing:

• Educate all health care team members aboutprofessional behavior, including training in basics,such as being courteous during telephone interactions,businessetiquetteandgeneralpeopleskills;

• Hold all team members accountable for modelingdesirable behaviors, and enforce the code of conductconsistentlyandequitably;

• Establish a comprehensive approach to addressingintimidating and disruptive behaviors that includes azero tolerance policy; strong involvement and supportfromphysicianleadership;reducingfearsofretributionagainst those who report intimidating and disruptivebehaviors; and empathizing with and apologizing topatients and families who are involved in or witnessintimidatingordisruptivebehaviors;

• Determine how and when disciplinary actions shouldbegin;and

• Develop a system to detect and receive reports ofunprofessional behavior, and use non-confrontationalinteraction strategies to address intimidating anddisruptive behaviors within the context of anorganizationalcommitmenttothehealthandwell-beingofallstaffandpatients.

When determining workplace actions that deal withbullying, however, caremust be taken to not unwittinglyescalate this behavior and drive it underground, Vesseynoted.Colleagueswhoarebeingbullied,forexample,maynot want to put someone else’s position in jeopardy if afacility’spolicyseemstoorigid.

Felblingerrecommendededucationalprogramsthatutilizebothcasestudiesandroleplayingthatcanbeaccomplishedthroughonlineandsmallgroupparticipation.

“Through those programs, nurses also can learn how todealwith abusive situations—whether it’s something thatissaidordoneunderstressornot.Weallshouldbeableto give meaningful apologies where one offers regret,takes responsibilityandoffersa remedy tocorrectwhat’soccurred.

“And a person getting an apology also has the option ofacceptingitornot.”

AsforotherpoliciesthathealthcarefacilitiesdevelopasaresultofJointCommissionalert,Felblingersaidtheymust

bepractical, helpful anduseful fornursesworkingat thebedside.And theymustbemeasurable toensure theyareeffective.

“We know there’s a problem,” Felblinger said. “We’velookedatitenough.Nowweneedtheinterventions.”

ConcludedMurray, every health care organization has aresponsibilitytoitsnursestoensurethattheyallfeelsafeintheirworkplacesandfeelsafetoreportanabusiveact.

“The nursing shortage isn’t a good excuse for badbehavior,” he said. “We’re not doing our profession anygoodifweusethatasanexcuse.”

For more information on the alert, go to www.jointcommission.org. For more on AACN’s standards,go to www.aacn.org/hwe, and for more on strategies,seeMurray’s article in the July issue ofAmerican Nurse Today.

Susan Trossman, RN, is the senior reporter for The American Nurse.

Reprinted from “The American Nurse”… an ANApublication

Behaving Badly continued from page 20

Clinical Nurse ManagerSeeking LICENSED RN with a minimum of three years of experience. Computer proficiency a must. Management experience in a physician office or other outpatient environment preferred. Previous experience with electronic medical records a plus. Position will supervise a staff of 20 comprised of RNs, LPNs, Medical Assistants, and LNAs in two locations.

Send resume and salary requirements to:[email protected]

or

Paula A. Roberge, Human Resources101 Boulder Point Drive, Suite 1

Plymouth, NH 03264


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