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PRSRT STD U.S. POSTAGE PAID FREDERICK, MD PERMIT #999 The Newsletter of the American Nurses Association-Maine www.anamaine.org FALL 2005 Sue Henderson ELECTED ANA-Maine President for 05-07 ANA-Maine is part of the American Nurses Association t is an honor to be elected president of ANA-Maine. Maine nurses have been linked to the American Nurses Association (ANA) since the early 1900’s. In 2001, the Maine State Nurses Association (MSNA) disaffiliated from the national American Nurses Sue Henderson Association (ANA). President ANA-Maine was formed to continue the work of a long tradition of affiliation with the American Nurses Association. In June 2001 at a meeting of interested parties, the new organization was born. Many of Maine’s nursing leaders were there representing all ages and all aspects of nursing. This meeting and the board meetings that followed increased my awareness of the accomplishments, skills, knowledge, vision, commitment and hopes of my Maine nursing colleagues for the I profession and for the people our profession serves. Perhaps the underlying message in those meetings that began ANA-Maine was that: through the years and through the hard times, the passion of caring continues, it is worthwhile and not futile. Nurses are smart, nurses are strong, and nurses have something very valuable to offer. So ANA-Maine is an organization that is built on the hopes, dreams, knowledge, skills, courage and wisdom of more people than I could name here. ANA-Maine stands for a tradition of seeking to build and strengthen the nursing profession so that it can give the very best care to the public it serves. example. Our board of directors has excellent members. Yet the strength of our organization depends on everyone. We need to strengthen and perfect our ability to work as a team within our state and with the national organization to achieve strategic objectives. Background information I would like to share a little of my background with you. I graduated from Saint Luke’s Hospital School of Nursing in New York City. I received by BS at Fairleigh Dickinson University in New Jersey. I worked at Columbia Presbyterian Medical Center and received my master’s degree in nursing from New York University. I came to Maine in 1973. In 1991, I completed a master’s degree in Public Policy and Management with a concentration in health policy analysis at the University of Southern Maine. I have taught nursing at Saint Joseph’s College since 1975. Through the years, I have worked as a per diem nurse at Mercy Hospital, the Cedars Nursing Center and presently, at Maine Medical Center. My roles as faculty member, staff nurse, and student of health policy give me a strange juxtaposition of perspectives. From this perspective, I see patients who are very sick and people who have great need. I see nurses working very hard and see their knowledge, skill and courage. Even in the face of the most difficult circumstances, nurses retain Continued on page 2 Passing the torch of leadership Joe Niemczura, the founding president of ANA-Maine, brought people together and provided the leadership that allowed a new organization to grow and thrive. In addition, he established the organization as a provider of ANCCCOA continuing education; he established the ANA-Maine Journal, was active in developing a legislative voice for ANA-Maine, and developed the legislative buddy program. On behalf of the Board of Directors and the membership, I say “Thank you, Joe, for all you have done, your energy and your vision.” Joe Niemczura has done an outstanding job serving ANA-Maine. As the new president, I feel humbled by all those who have gone before me; yet also empowered by their Highlights Sue Henderson Elected ANA-Maine President for 05-07 . . . . . . . . . . . . . . . . . . 1 ANA-Maine unveils new email system . . . . . 2 News from Biloxi . . . . . . . . . . . . . . . . . . . . . 3 ANA-Maine Membership Application. . . . . . . 6 ...and lots more! Link to Online Journal of Nursing article on workplace violence. . . . . . . . . . . . . . . . . . . . 9 Continuing Education Calendar . . . . . . . 10-11 Shorts . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Dear Colleagues, The American Nurses Association-Maine is pleased to announce an exciting new partnership with the Arthur L. Davis Publishing Agency. Beginning in November 2005, the ANA-Maine Journal, our official publication, will be distributed to every licensed Registered and Practical Nurse in the state. This newsletter will also be extended to each student nurse in Maine, every school of Nursing, and each of our Maine and United States legislators, for a total quarterly circulation over 20,000. The ANA-Maine Journal is the official publication of the American Nurses Association-Maine, a state constituent of the American Nurses Association that offers membership to all registered nurses in our state. Why then is the ANAMaine Journal also being sent to LPNs and students? We believe the information that we publish will benefit all licensed nurses as well as those individuals pursuing nursing careers. Sharing information through the ANA-Maine Journal increases the nursing profession’s visibility, communication, and ultimately, the voice of nursing across our state. The American Nurses Association-Maine Board of Directors felt that this was an important, timely and critical initiative to reach the entire population of nurses in our state. The ANA-Maine Journal will publish educational, legislative, political, economic, and professional information that is critical to nursing practice, regardless of specialization. It will also give you an opportunity to get to know the American Nurses Association-Maine. The American Nurses Association-Maine has a long history of representing nurses and advocating for issues that impact our profession. As you become familiar with American Nurses Association-Maine goals, activities, opportunities for leadership, and accomplishments on behalf of nurses in Maine, we hope that you join the nursing professionals who are already members. There is so much more we can do together to promote and further the nursing profession in Maine. We would also like to take this opportunity to encourage submission of news articles and information relative to the profession and environment in which nurses practice. If you are interested in submitting items for inclusion in the ANA-Maine Journal, please email your information to Joe Niemczura, RN, MS at anamaine@prexar.com or contact him at 207-667-0260. We look forward to a long and mutually beneficial partnership with our new publisher and the nurses of Maine. Through this collaborative effort, American Nurses Association-Maine will bring ALL Maine nurses together. Sincerely, Joe Niemczura, RN, MS President, ANA-Maine ANA-Maine unveils new email system e continue to revise our system of email. ANA-Maine has an email database of 2,600 nurses, the most comprehensive list in the state, and we want to add more! Join our list. It is not spam. We will inform you of coming events in real time so you can be a part of things. Be advised that if you have aol, you need to adjust the settings on your machine to allow it to accept our mailings. The officers below have email accounts through ANAMaine: Susan.Henderson@anamaine.org Paul.chamberland@anamaine.org Diana.Crowell@anamaine.org Susan.McLeod@anamaine.org Bettie.Kettell@anamaine.org Ed.Latham@anamaine.org Nancy.Mattis@anamaine.org Bob.Best@anamaine.org Peggy.Danis@anamaine.org The address anamaine@prexar.com will still work. In addition, if you need generic advice, send to: info@anamaine.org For newspaper-related feedback, send to: publications@anamaine.org For CE, you can still send to the previous address, anamainece@gwi.net And if you get a listserve message but wish to opt out, send to: unsubscribe@anamaine.org President’s Message Continued from page 1 the ability to care and to work to make things better. I believe that the voice of nurses and the voice of patients needs to be clearly heard in health policy decisions. I believe that nurses need a national nursing organization in order to have that voice and to advocate for their patients. ANA is our national organization and ANA-Maine is our state constituent assembly. Through these organizations, we as nurses can have a voice in improving patient care, decreasing cost and increasing assess to care. W A national voice through ANA is critical to the success of nurses everywhere Everyday as we practice, we depend on ANA’s critical work to protect our practice, our patients and our selves. The work of ANA in advocating for the public and for the profession is critical. The Code of Ethics with Definitiative Statements is an example of a publication essential to our practice. ANA has Core Initiatives on the Nursing Shortage, Patient Safety/advocacy, Workplace Rights, Appropriate Staffing and Workplace Health and Safety. Programs such as governmental affairs, the Magnet Recognition Program, nursing quality (NDNQI) and Back Injuries: Handle w/Care are just a few of the initiatives that improve our patient care and help to keep us safe while practicing. ANA’s work forms a basis for defining our profession, our practice, quality outcomes and for providing protection for patients and nurses. Published by ANA-Maine, part of the American Nurses Association www.anamaine.org Accept no substitute. www.ana.org. P.O. Box 3000 PMB #280 York, ME 03909 Officers: Susan Henderson, MA, RN President, South Portland, susan.henderson@anamaine.org Paul Chamberland, MSN, APRN, BC, CMSRN First Vice President, Scarborough, paul.chamberland@anamaine.org Agnes Flaherty, MSN, RN, BS-PHN Second Vice President, South Portland, agnes.flaherty@anamaine.org Elaine McCarty, MSN, RN Treasurer, Auburn, elaine.mccarty@anamaine.org Susan McLeod, BSN, RN.C, BC Secretary, Smithfield, susan.mcleod@anamaine.org Directors Diana Crowell, PhD, RN, CNAA Kittery, diana.crowell@anamaine.org Gail Dudley, RN Belfast, gail.dudley@anamaine.org Bettie Kettell, RN, HEM Durham, bettie.kettell@anamaine.org Ed Latham, RN, FNGNA South Portland, ed.latham@anamaine.org Nancy Mattis, BSN, RN.C Portland, nancy.mattis@anamaine.org Mary-Ann Ponti, RN, MS, MBA Manchester, maryann.ponti@anamaine.org The ANA-Maine Board meets quarterly. Meetings are open to members of ANA-Maine. Contents of this newsletter are the opinion of the author alone, and do not reflect the official position of ANA-Maine unless specifically indicated. We always invite leaders of specialty organizations to contribute. We welcome submissions, but we reserve the right to reject submission of any article. Send to publications@ anamaine.org CE calendar listings are free. Attribution: We do not knowingly plagiarize.We encourage our authors to fact check their material but we do not assume responsibility for factual content of ads or articles. Ad rates and contract are available from the Arthur L. Davis Publishing Agency, 517 Washington Street P.O. Box 216 Cedar Falls, IA 50613 319-277-2414 800-626-4081 Fax 319-277-4055 sales@aldpub.com We reserve the right to reject advertising not consistent with our ad policies. Address corrections: this list of addressees is obtained from the Maine State Board of Nursing each issue. Keep your address current with them and this too shall be updated. YOU can become part of US! Join ANA-Maine as we fight for health care Join ANA-Maine to help your professional organization help you. I will work to help our organization support the work of ANA within our state and within the nation, increase our membership, seek to further develop the infrastructure of our organization and seek to have our organization serve as a voice for Maine nurses. Join with us. (editor’s note: Sue Henderson, RN, MS was elected to a two-year term as President of ANA-Maine in Oct 2005. visit our website www.anamaine.org for information on the association, and go to www.nursingworld.org for information on the programs and positions of the American Nurses Association). PAGE 2 FALL 2005 ANA - MAINE JOURNAL News from Biloxi MT Joshua Frances has a clear view of the Atlantic Ocean from the hospital where he is working. Problem is, he shouldn’t. The ocean is four blocks away, but the buildings that normally would obstruct his view no longer stand. They were literally blown away when Hurricane Katrina hit Biloxi, Mississippi, leaving behind a rutted, debris-strewn wasteland. “There was a 30-foot storm surge here, and when the ocean rushed back, it took a lot of things with it,” said Frances, who spoke to HPH NOW from the Gulf Coast Medical Center in Biloxi. “Now, when the tide goes out, it reveals cars, tractors, and pieces of buildings like McDonald’s scattered in the sand. The storm surge was sort of like the December tsunami—but add 150 mph winds.” Frances was deployed to the medical center as part of a Federal Emergency Management Agency (FEMA) response and a Massachusetts-based Disaster Medical Assistance Team (MA-1-DMAT). He is a program coordinator at the HSPH-Center for Public Health Preparedness and is studying for a masters of public health focusing on emergency preparedness at the University of New England. Frances started his career with a paramedic service in New York doing disaster preparedness, and more recently, working in the Boston Police Command Center for the City of Boston before joining HSPH. “Whatever you are seeing on TV, the devastation is worse,” said Frances. “There are 40-foot piles of rubble lined up along the streets, like snow banks after a big winter storm in Massachusetts, but the rubble is made of people’s property. The piles are what made people’s lives.” Frances was in New York when he got the call that the DMAT team would be deployed two days before the hurricane struck. On Saturday, August 27 the team flew to Atlanta, Georgia, and then drove three hours to Aniston, Alabama, where FEMA, which had activated all of the DMAT teams, gathered some of them. Then, the hurricane hit. The nation’s worst natural disaster was also Frances’ trial by fire. This deployment was his first with the DMAT team. The next day, the Massachusetts team traveled to Mississippi. The 35-member group, made of doctors, nurses, paramedics, pharmacists, and other health care workers, train together several times a year and can be tapped at any time to respond to disasters in the U.S. or in other parts of the world. In the past, the Massachusetts team has been deployed in response to Hurricane Andrew in Florida, Hurricane Marilyn in St. Thomas, and an earthquake in Bam, Iran. They bring with them a 35-bed mobile hospital that can sustain itself for 72 hours before needing more supplies. All DMAT teams are in the National Disaster Medical System, part of the U.S. Department of Homeland Security. In the hurricane’s aftermath, the Massachusetts team drove along damaged roadways to Forrest General Hospital in Hattiesburg, Mississippi, where they helped evacuate numerous critically ill patients using J-Hawk helicopters, buses, and ambulances. The hospital had lost electrical power and water pressure, crippling medical equipment. The emergency room managed to stay open, and the DMAT team set up their mobile hospital for three days, treating about 100 to 150 patients, until the hospital regained its electricity. “At that point, our work is done, and it’s time to go to the next site,” explained Frances. The team moved on to Biloxi and neighboring Gulfport, where Frances is deployed now and where the huge storm surge and winds have knocked out the lower halves of some buildings, leaving the upper halves perched on surviving support beams. The recessed water has left behind a layer of sludge baking in 100-degree heat, and the air smells of sewage, sea creatures, and decomposing matter, said Frances. “The emergent disaster response has evolved into a public health mission,” said Frances. “You have two categories of patients: people who were injured by the A Message From Joe This is the eleventh issue of this newspaper, and it has been a privilege to be the editor, along with being the President of ANA-Maine during the last four years. I truly appreciate the kind words from Sue Henderson which appear in her President’s message. Sue will now be the principal spokesperson for all nursing issues in Maine. She will be there to speak up when nurses are not getting a fair shake in the media or in Augusta. I ask you to support her as you supported me in the last few years. Her email address is shenders@ maine.rr.com or also susan.henderson@anamaine.org Looking back on the things we accomplished, I did not do any of it alone. I suppose I could best describe myself as “the idea guy” who was fortunate to have others who could see the vision and make it happen. The members of ANA-Maine know that there are challenges to overcome, but I thank them for their positive attitude and “can do “ spirit, which created a lot of energy. There are many people to thank for their help and support in these last few years . . . I hope to post a message listing all such persons on our website . . . I could fill this entire newspaper just with the list. God Bless all of you! There is benefit when there is dialog. That is why I am happy to see Sue Henderson become the next President of ANA-Maine. She is a tireless advocate for nursing. Sue has always been a good listener. She teaches at Saint Joe’s but you may see her hustling up and down the halls on 3to-11 at Maine Med because that is where she has a parttime job as a staff nurse. She has firsthand current knowledge about the pressures of nursing care at the bedside. ANA-Maine has strived to be inclusive, present a pro nursing viewpoint, highlight all the good endeavors which could benefit all the people of Maine, and to present people with information as to the valuable and important work done at the national level by the American Nurses Association. I know that Sue will continue this legacy. My last words as the soon-to-be-former President: Join ANAMaine and be a part of the solution! (editor’s note: the rumor you have heard is true: Joe is spending the winter in Honolulu. He does not own a woodstove there. He will not be shoveling snow. But he can still be reached at the same old email address, josephn@prexar.com) E storm and the initial clean-up and, now, people who are coping with pre-existing conditions, such as diabetes, who kept their prescriptions in their bathrooms, only to find their bathrooms don’t exist anymore.” The team has dispensed prescriptions for chronic conditions and has provided oxygen to patients whose home units depend on electricity. In three days, the team has delivered over 250 doses of tetanus vaccines, trying to treat and protect relief workers and residents who are picking through jagged, filthy debris. And then there is the simple human factor. Frances has seen hundreds of survivors, each with a story to tell. “I remember giving a tetanus dose to an elderly woman who had gone back to her house to find a family photo album,” said Frances. “The first floor was filled with water, and I knew that album had probably been swept away. She had lost everything, but what she really wanted was that album.” Frances is unsure when he will return home. A usual deployment lasts no longer than 14 days, but, Katrina was no usual hurricane. Frances and his colleagues have been sleeping on floors and showering with cold water from make-shift showers. “I’m not complaining,” he said. “I signed for up this.” An expert in rural bioterrorism preparedness, Frances will bring back lessons learned to the HSPH-Center for Public Health Preparedness, as well as to state officials in Maine, with whom he works as part of his Center duties. He has not watched much television but knows that FEMA, of which he is a temporary federal employee, has come under heavy criticism. Safety is the number one concern for the team, said Frances. As it is, the team is constantly guarded by federal agents. “Disasters bring out both the best and the worst in people,” said Frances. “I know that people have seen some really bad stuff on TV, horrible stuff, but I have also seen how communities pull together.” While at the Gulf Coast Medical Center in Biloxi, Frances found photos of the surrounding neighborhood. “This was a beautiful place,” he said. “Now, there is nothing.” Josh Frances Harvard School of Public Health Center for Public Health Preparedness Maine-Harvard Bioterrorism program jfrances@hsph.harvard.edu 617 496 1087 Emergency preparedness Monthly- monthly email listemail: epmonthly@hsph.harvard.edu and write “subscribe” in the subject line (editor’s note: ANA-Maine has worked consistently since 9-11 to promote disaster training among Maine nurses. See last issue’s report from Louise Wakefield, RN of the American Red Cross. We printed it before the hurricane, and it is even more timely now. We encourage all RNs to consider disaster response training). www.anamaine.org FALL 2005 PAGE 3 From the Mississippi Nurses Association I thought you would like to hear what the Katrina experience has been like for our nurses in Mississippi. * From Pam McVey, at Biloxi Regional Medical Center- A large percentage of our staff have suffered catastrophic losses of homes and belongings. Many, many, many of us have lost absolutely everything we own, myself included. My home was in an area in Pass Christian that is so badly damaged that the National Guard and the EOC cannot even get to it yet. * From Shirley Bertalosi, at Crosby Memorial Hospital in Picayune-We lost part of the roof on the second floor (surgery) in late morning. The elevator became a waterfall; the stairwell a river. We had to close down our main trauma/cardiac room in the ER when the ceiling came crashing down. The conditions that our nurses have had to endure have been more challenging than we ever could have imagined. But they have persevered. * From Pam McVey, at Biloxi Regional Medical Center-It is a tribute to our staff that the patients never panicked. Because the staff never let on how scared they were. They were calm and confident, professional and positive, the commitment and dedication to the great responsibility of caring for the patients in our community that have been entrusted to our care and protection has been evident this week. I can’t say that I wish this experience on anyone, but I do know that it is and will continue to be a life changing experience. The facilities that provide care to Mississippians will eventually be repaired by public and private sector funds. Unfortunately, the personal needs of our nurses are harder to meet without help from others around the nation. * From Shirley Bertalosi, at Crosby Memorial Hospital in Picayune—It’s a daunting task to rebuild your household and your life—cars, clothes, furniture, lines, pots and pans, dishes, the list is long. There’s a lot of waiting—on insurance adjustors, paperwork, utilities, supplies, contractors. To many, everything appears to be at a standstill while they remain in limbo. They keep going every day but the stress is visible in their body language and in their eyes. The Mississippi Nurses Association wants to help our nurses get back on their feet-we want them to regain some of the normalcy that Katrina took from them. If any of your nurses would like to help a specific group of nurses on the coast, we would like to facilitate matching Mississippi nurses’ needs with your nurses’ generosity. Please let me know if there is an interest in helping, and we will put you in touch with a specific group of nurses whose needs your group is interested in addressing. Again, thank you for the great generosity shown to our state and, in particular, to our nurses. Ricki Garrett Executive Director Mississippi Nurses Association 601-898-0670 Michaud Co-sponsors Nurse Education Bill ashington, D.C—Congressman Michael Michaud recently agreed to co-sponsor H.R. 3569 the Nurse Education, Expansion, and Development Act of 2005, which would provide capitation grants to nursing schools in an effort to increase the number of nursing faculty and nursing students. “This important legislation would increase the ability of nursing schools to provide a top quality education to those who want to enter the nursing profession,” said Michaud, a member of the Congressional Nursing Caucus. “Maine nurses play a critical roll in our health care delivery system and this legislation will help increase the number of students that nursing schools are able to accept and in turn will help ensure that highly trained nurses remain a mainstay of health care in Maine.” Grants under the Nurse Education, Expansion, and Development Act could be used for enhancing clinical laboratories, recruiting students as well as hiring and retaining faculty. H.R. 3569 is currently before the House Committee on Energy and Commerce, Subcommittee on Health. (editor’s note: Mr. Michaud was endorsed by ANA Pac in the last two election cycles. For more information on nursing political activism, go to www.anapolitical power.org) W Six Hundred Qualified Applicants Turned Away From Maine Nursing Schools Lisa Harvey-McPherson, RN, MBA, MPPM Jane Kirschling, RN, DNS The first session of the 122nd Legislature represented a continuation of strategic initiatives supported by OMNE— Nursing Leaders of Maine that began four years ago. These initiatives are focused on addressing the resources needed by Maine’s schools of nursing to produce the nursing workforce based on current demand and to plan for future. of Southern Maine (552 enrolled and 126 graduates) as a result of internal reallocation of budget. Unfortunately, neither of these institutions can support additional growth, nor can the other state supported nursing programs, without new appropriation. It is estimated that 600 qualified applicants were placed on waiting lists or turned away from Maine’s nursing programs 2003-2004. Maine must educate a new generation of nurses to effectively deal with the nursing workforce shortage. Plan to address workforce issues Background on workforce data Based on data collected from over 15,000 Maine nurses, Maine RNs are on average 49.4 years of age making them older than the national average. A total of 84% of Maine’s RN report working as a nurse, this is in contrast to 82% nationally. Of the Maine RNs actively working the most common site of employment being a hospital (51%) followed by long term care (13%), other (10%), ambulatory care (8%), and home health care (6%). Ninety-two percent of nurses report that they plan to be working in nursing in 5 years. For those RNs not working in nursing, the majority are retired (28%) followed by family responsibilities (18%) and health problems (11%). In fall 2004, Maine’s schools of nursing employed 146 full-time faculty, of which 45% were between the ages of 51 and 60 and 13% were 61 years of age or older. The nursing faculty are “graying” and retirements will place additional pressures on the educational programs. The Maine Department of Labor projects that between 2002 and 2012 there will be 3,469 additional jobs for RNs (27% growth) and that the annual openings will be 619 positions, 347 due to growth and 272 due to replacement. In 2002, HRSA projected that Maine will experience a shortfall of 1,764 RNs in 2010, 3,372 in 2015, and 5,211 in 2020. The “good news” is that enrollment in and graduations from Maine’s 13 nursing programs have grown: enrollments 1,342 in 2000-2001 to 2,302 in 2003-2004 and graduations 425 in 2000-2001 to 570 in 2003-2004. Just under half of this growth has occurred at the University of Maine (490 enrolled and 78 graduates) and the University Resulting from work that OMNE began in the 121st legislature, the Legislature’s Committee on Education and Cultural Affairs received a report from the University of Maine System and Community College System that outlined a strategic plan to increase nursing student capacity. Key to increasing capacity is funding to support the addition of nursing faculty. Toward this goal, two bills were submitted during the legislative session; LD 1494 “An Act to Increase Faculty in Maine Nursing Education Programs” and LD 263 “An Act to Support and Expand Nursing Education Opportunities at Maine’s Public Universities”. LD 263 “An Act to Support and Expand Nursing Education Opportunities at Maine’s Public Universities” was sponsored by Senator John Martin of Aroostook and Cosponsored by Representative Anne Perry of Calais, Senator Mike Brennan of Cumberland, Representative Emily Cain of Orono, Representative Glen Cummings of Portland, Representative Jeremy Fisher of Presque Isle and Representative Sawin Millett of Waterford. This bill in its original text provides for an appropriation of $1,000,000 to the University based school of nursing programs. With negotiations among members of the Appropriations Committee, support was gained to add an additional $700,000 to include the Community College System nursing programs. As the legislative session came to closure, the Appropriations Committee voted to carry over LD 263 to continue efforts to pass this legislation during the upcoming session. Continuing support is needed Maine’s nursing community is fortunate to have increased recognition of the issues related to the workforce shortage, widespread respect for our profession and bipartisan support in addressing the capacity challenges within the schools of nursing. As we continue our efforts during the next session, we encourage all nurses to engage in the process by contacting your local legislators and partner with them to support final passage of LD 263. No summary of the legislative session would be complete without special recognition of the effort put forth by Representative Darlene Curley of Scarborough to address the nursing shortage and capacity needs of the schools of nursing. Representative Curley, a nurse legislator, has championed the issue of nursing workforce and the critical importance of nursing to the citizens we serve and the reality of nursing as a job growth opportunity for the State of Maine. We thank her for her outstanding leadership and advocacy. (editor’s note: ANA-Maine also supported these initiatives. Lisa Harvey-McPherson RN, MBA, MPPM is the Director of Health Policy & Continuing Care for Eastern Maine Healthcare Systems and Chairperson of the Legislative Committee for OMNE-Nursing Leaders of Maine. Jane Kirschling is Dean and Professor of Nursing at the University of Southern Maine, College of Nursing and Health Professions. jane.kirschling@usm.maine.edu) Nurses: take note of these legislative sponsors and thank them for their support! LD 1494 “An Act to Increase Faculty in Maine Nursing Education Programs” was sponsored by Representative Glen Cummings of Portland and Cosponsored by Senator Mary Black-Andrews of York, Representative Darlene Curley of Scarborough and Representative Anne Perry of Calais. This bill, subsequently passed into law, creates the Maine Nursing Faculty Loan Repayment Program. The loan repayment program will provide two levels of loan repayment for nurses who complete a Masters or Doctoral degree and agree to teach in any Maine school for nursing for a minimum of three years. While we were successful in passing the statutory language to create the program, we were not able to include an annual appropriation of $50,000 to fund the program. Certainly work will continue to obtain the funding needed. PAGE 4 FALL 2005 ANA - MAINE JOURNAL Federal Sex Education Funding: strings attached? s parents, we want our children to delay sexual activity as long as possible. We want them to be informed about health issues. And, we want education standards to be effective. A History of Family Life Education in Maine These are just some of the reasons that Maine communities, legislators, and administrations of four Maine governors—Brennan, McKernan, King, and Baldacci—have supported comprehensive family life education that includes an abstinence focus in our schools for at least 20 years. This approach is proven to be effective both nationally as well as in Maine. In the 1970s and 80s, Maine had one of the highest white teenage pregnancy rates in the country, with one in fourteen teens becoming pregnant. Governor Brennan then convened the Governor’s Task Force on the Prevention of Adolescent Pregnancy and Parenting. The road map this task force drew–of Maine schools adopting abstinence-based comprehensive family life education as the standard–was based on multiple studies showing that when youth are given full information, they make the healthiest choices possible. Indeed, that strategy resulted in one of the best national public health successes of the past several decades. Maine’s teen pregnancy rate is now the one of the lowest in the country, seeing the steepest decline in the nation over the past 20 years. And, both teen birth and abortion rates have declined. Abstinence among Maine high school students is now at 57%-an increase from 46% in just 10 years. And, those Maine teens who are sexually active are more likely to use contraception–37% of sexually active Maine youth use birth control pills compared with 17% nationally. A 1998 study of Maine’s success in reducing teenage pregnancy by the Centers for Disease Control and Prevention found an association between the adoption of the abstinence-based comprehensive family life education standard in Maine schools and the steep declines in teenage pregnancy. prevalent sexually transmitted disease among teens in this country. By contrast, rates for this infection among teens nationally have increased the past 10 years. The Maine Legislature continues to affirm our standard of comprehensive family life education, even enacting in 2002 a statute defining this as, “education in kindergarten to grade 12 regarding human development and sexuality, including education on family planning and sexually transmitted diseases, that is medically accurate and age appropriate; that respects community values and encourages parental communication; that develops skills in communication, decision-making and conflict resolution; that contributes to healthy relationships; that promotes responsible sexual behavior with an emphasis on abstinence . . .” Maine people and communities continue to show their support for a comprehensive approach to family life education. A 2002 survey showed 88% of Mainers support age-appropriate sex education in their local schools. Maine’s network of family life education consultants is a trusted resource that receives more requests than they can fulfill each year from both schools and communities. Federal Government Restrictions on use of Funds However, the Federal Government in 1996 made funds available for abstinence-only until marriage education. These funds came with eight principles defining abstinence-only education. These principles include teaching that only sexual activity that is part of a monogamous marriage is the expected standard; that any other sexual activity is harmful psychologically and physically; that children born out-of-wedlock suffer harmful consequences; and that self-sufficiency should be attained before people engage in sexual activity. In the early years of these funds, the eight principles could not be violated, and states were allowed to focus on just three of the principles. Maine used the approximate $165,000-$170,000 Federal funds, along with the required state match of about $120,000 to produce and air narrowly-focused television ads, promoting the benefits of teenage abstinence and communication between parents and children. These ads were aligned with three of the principles that we have long supported. Maine and across the country. An independent evaluation of our media campaign showed no evidence of resulting behavior changes among those teens who remembered the ads. And, even after 8 years of substantial Federal funding for this approach, no credible scientific research exists that supports the effectiveness of abstinence-only until marriage programs. Second, we received guidance from the Federal agency overseeing these abstinence-only until marriage funds to adhere equally to all eight principles. It would therefore be nearly impossible for us to adhere to all these principles and continue a narrowly-focused media campaign. It was also clear to us that adhering to all eight principles tied with these abstinence-only until marriage funds would mean potential harm to our youth. For instance, teaching these principles would mean hiding information about pregnancy prevention and sexually transmitted diseases. Research shows that restricting such information puts young people at greater risk. It would also mean putting at risk the health, safety, and dignity of our youth who are born out-of-wedlock, have been sexually abused, are gay or lesbian, and have gay or lesbian parents. Therefore, we realized we could no longer continue applying for these funds and stay in compliance with the long-standing standard in Maine of abstinence-based comprehensive family life education. In an era in which government needs to be as effective and as efficient as possible, we found it unacceptable to be turning our backs on strategies with a proven track record, and instead applying for funds to implement a program that is proven ineffective and that is potentially harmful. For the health of Maine youth of today and tomorrow, we want to build on the 20-year legacy of success in Maine by continuing to provide the opportunity for our youth to be taught abstinence as well as to receive full information about their health. Dora Anne Mills, MD, MPH Public Health Director Maine Health and Human Services’ Public Health dora.a.mills@maine.gov Sexually Transmitted Diseases With the worldwide emergence of life-threatening and even fatal infectious diseases such as HIV and Hepatitis B, it is even more important today that our youth receive full health information. Indeed, Maine’s teenage rates of sexually transmitted diseases are lower than other states and are on the decline. For instance, Maine has seen steady reductions the past 10 years in Chlamydia, the most Decision not to re-apply for these funds However, two issues evolved that contributed to our recent decision to not re-apply for these funds. First, it became clear to us these dollars were ineffective both in www.anamaine.org FALL 2005 PAGE 5 There are no “PILLs” in Infusion Therapy by: Gweneth E. Cole, RN, CRNI It was made up long ago by folks trying to distinguish between short, peripheral catheters and the new-fangled longer IV catheters that were suddenly showing up in patients. The term was never adopted by the Infusion Nurses Society (INS) because it doesn’t have a definitive meaning. It doesn’t reveal the “catheter tip location”. It means many different things to many different practitioners. In 1997, INS denounced the use of the term “PILL” along with other inaccurate names such as: halfway, extended peripheral, and PIC. It then published the only nomenclature that is acceptable in the language of infusion therapy. This is the only verbiage you will find in the INS Standards of Practice, which all practitioners of infusion therapy to any degree, will be held to in a court of law. They are as follows: Short peripheral IV catheter (no acronym): Any catheter <3” in length. Midline catheter (no acronym): These catheters are between 3” and 10” in length. They are inserted in the antecubital area with the tip location proximal to the axillary vein. They are considered a “peripheral” line. They are available with a distal tip which is either openended or sealed with a Groshong Valve. Peripherally Inserted Central Catheter (PICC): These catheters are 55 to 65 centimeters long and are inserted in the antecubital area with the distal tip location in the superior vena cava (SVC). Again, they are available with a distal tip which is either open-ended or sealed with a Groshong Valve. Central Vascular Access Device (CVAD): Any IV catheter whose tip is located in the SVC. They vary in design, length, number of lumens, and insertion site location. They are also available in both open-ended and Groshong Valve distal tips. These are the catheter names that should be addressed in your facility’s Policies and Procedures. These are the catheter names that your dispensing pharmacy can accept when preparing solutions, medications, and proper flushing supplies. When you come across a patient with an IV catheter whose name does not meet the above INS recommendations, simply get a report on the location of the distal tip of the catheter. If that info is not readily available, then have a chest x-ray done to verify the distal tip location. Ask the radiology department to include the appropriate shoulder, upper arm, or neck area in the film if you suspect that the distal tip is NOT in the SVC. Many IV solutions and medications (i.e. TPN and Adriamycin solutions) will not be able to be infused unless the distal tip location is in the SVC. You may have noticed that I have not even mentioned the term “mid-clavicular.” This distal tip location is mostly due to a PICC attempt that failed to thread all the way to the SVC. Rather than pull out the catheter, it is determined that it will be used, as is! INS does not recommend the use of this distal tip location for many reasons. Picture if you will, a catheter tip in the SVC. It is in a “vertical” position, dangling down. The blood flow around the catheter (and gravity) keeps the tip in the center of the vessel. Now let’s imagine the distal tip in the axillary or subclavian vein. It is now in a “horizontal” position in a much smaller vessel with less blood flow around it. The tip of the catheter actually “whips around” damaging the vessel wall. If it was a short, peripheral catheter, you would see a pink streak up the vessel from this activity and would remove the catheter. As you know, we can not visualize what is happening in the chest vessels. As this irritation increases, the vessel tries to protect itself by making a clot to curtail the whipping. This clot increases in size and T he acronym “PILL” (peripherally inserted long line) has always been a misnomer. slows the blood return from the affected arm. The first sign you have that there is a problem is when you note that the arm is swelling. By this time, you have a good sized thrombus growing in the subclavian vein! You also shouldn’t infuse caustic medications (i.e. Vancomycin) into a catheter with a mid-clavicular tip because they add further insult to the irritation. A safer practice for when a PICC placement has “come up short,” would be to have the practitioner try to change the PICC over a wire, repositioning the patient, and attempting to thread again. By always using correct terminology to describe our patients’ catheters, we can continue to provide our patients with safe and competent infusion therapy. (editor’s note: Gwen Cole, RN, CRNI lives in Oakland and owns her own business, PICC a little TALK a little! You can contact Gwen at: gwencrni@adelphia.net) PAGE 6 FALL 2005 ANA - MAINE JOURNAL Part Two: Shining a Spotlight on Patient Safety and Quality The Patient Safety Movement Launches New Approaches to Errors in Healthcare by Lois Skillings, RN, MS lskillin@midcoasthealth.com ince the hallmark study, “To Err is Human: Building a Safer Health System” was published by the Institute of Medicine in 1999, much greater attention has been focused on improving the quality and safety of patient care. What principally caught the attention of healthcare professionals and consumers about this study was its conclusion that nearly 100,000 preventable patient deaths occur each year in hospitals across the country as a result of medical error. The Institute of Medicine has stressed that this is more deaths per year than are caused by breast cancer and car accidents combined. Every day nurses are on the front lines of ensuring patient safety. But healthcare has never been more complex, and with this increasing complexity comes greater risk and opportunity for error. This article will address three essential components of the “patient safety movement” that was launched by this Institute of Medicine study. First, an emphasis on implementation of systems or safety engineering rather than assessing blame to individual health care professionals when things go wrong. Second, an effort to make errors and quality improvement activities transparent, so that everyone can learn from individual mistakes and consumers can be well informed. And third, promoting recognition that a culture of safety within our healthcare organizations is critical if we are to truly transform our organizations away from “blame and shame.” It is all about the culture of safety In order to transform our healthcare organizations to a culture of safety, all levels of the organization must abandon fear, blame and shame about errors. To be successful, leaders must foster an open exchange of ideas that optimize safety. They must encourage the reporting of “near miss” situations, so system solutions can be implemented. This is not to say that individuals should not be held accountable for practice concerns or competency issues. In fact, the ANA Code of Ethics stresses our individual responsibilities to safeguard our patients from incompetence and to assume responsibility and accountability for our individual nursing judgments and actions. However, this approach to patient safety embodies a recognition that the human factor does not discriminate when it comes to errors. Even the most expert, conscientious professional can make a mistake. That is why we need safety nets and engineering systems in place to help prevent errors. Examples of implementing a non-punitive culture include “great catch awards,” which recognize staff for identifying “near miss” or potentially hazardous situations. Another example involves organizational leaders participating in formal safety rounds, meeting with staff to discuss safety concerns and observing the environment. The test of a culture of safety is also how leaders respond with staff when an error occurs. Is this a learning experience? Was there a system component? How can others learn from this situation? Systems approach, transparency and a culture of safety are all aspects of the great momentum of the patient safety movement—a movement in which it is vital that all nurses play a role. To quote the IOM study: “A comprehensive approach to improving patient safety is needed. The approach cannot focus on a single solution since there is no ‘magic bullet’ that will solve this problem, and indeed, no single recommendation should be considered as the answer. Rather, large, complex problems require thoughtful, multifaceted responses.” (p. 3) Nurses are definitely up to this challenge and every day practice on the sharp edge of keeping patients safe and improving our healthcare organizations. I am personally inspired by the solutions and ideas sparked by nurses to promote patient safety and invite everyone to join in this movement. Our patients are counting on us! References: (Below are some of my favorite patient safety texts, where you can read about a lot of the important concepts described above in much greater detail) Kohn, L., Corrigan, J., Donaldson, M., Editors. To Err is Human: Building a Safer Health Care System. (1999). Institute of Medicine. National Academy Press: Washington, D.C. Aspden, P., Corrigan, J., Wolcott, J., Erickson, S., Editors. Patient Safety: Achieving a New Standard for Care. (2004). Institute of Medicine. National Academy Press: Washington, D.C. Morath, J., Turnbull, J. (2005). To Do No Harm. Jossey-Bass: San Francisco Fowler Byers, J., White, S. (2004). Patient Safety: Principles and Practice. Springer Publishing Company: New York, NY S Systems prevent errors As a new nurse manager twenty years ago, I would log all medication errors in a notebook by time, type of error, etc, to identify trends. I noticed that the greatest number of omissions were with 9PM and 10PM meds, so I asked several evening nurses if they had any ideas about why this pattern occurred? We soon discovered that our medication cart was in the hallway of the nurses’ station, and the lights in the hallway were turned out at 9pm. The evening meds were noted on the MAR in green (remember those days of green color for evenings?), and it was very hard to see that the medication was due. We suggested that a spotlight be installed over the medication cart, and noticed a significant and immediate reduction in errors of omission! This was my first experience realizing that our systems can either promote or prevent errors. Today we recognize that our computerized medication records, computerized physician order entry, and bar-code medication administration systems are all examples of engineering safety nets designed to reduce errors. Other examples of a system approach to preventing errors include the “time out” protocol before surgery and removing concentrated potassium from patient care areas. All of these systems are saving lives. In fact, today’s safety science also teaches us to use analytical tools to prevent error, such as “root cause analysis” and “failure mode and effects analysis.” A root cause analysis is a careful dissection of an error, branching down every collateral artery until all the factors which influenced the error are visible. Only after doing this is it possible to clearly see the kind of systems that might be put in place to reduce the likelihood of the error in the future. Failure mode and effects analysis systematically identifies in advance everything that could go wrong with a process. It then identifies the relative likelihood of each possible failure, which in turn prioritizes which system needs a safety net (I find failure mode and effects analysis to be a great exercise for the worry-wart in all of us!). While some of these approaches may seem redundant—and they certainly take extra time— we have learned that healthcare needs to take a lesson from other industries in which safety is important—for example aviation, which has long been using these same kinds of analytical methods and safety nets successfully, rather than relying solely on individual accountability and memory. Witness the extremely extensive and thorough analysis the Federal Aviation Administration of every plane crash. Transparency is an expectation Over the past decade, healthcare organizations have been more and more open about errors, and this openness is often called “transparency.” Openness is the only correct ethical response when things go wrong. Patients and their families have a right to full disclosure at such times. Openness is also essential for healing to begin for everyone affected by the error, and for endeavors to prevent future errors. There is growing recognition that everyone involved needs support when errors occur, including patients, families and staff. It is very easy to understand the range of possible, very human, responses—e.g., a sense of betrayal, defensiveness, loss of trust, anger and grief. Organizational leaders need to communicate openly and support patients, families and staff through these events. Another aspect of transparency is the notion of sharing these experiences with others, to raise an alert that enables everyone to learn and hopefully prevent future errors. This is the basis of the JCAHO Sentinel Alerts that are published after gathering information on critical incidents and how JCAHO’s National Patient Safety Goals are determined. The goal of the Alerts is to bring about system changes or best practices that can prevent a similar error from recurring. With this degree of attention directed to error prevention and transparency, it becomes important to differentiate between patient complications and true system errors. Experienced clinicians realize that a great deal of healthcare is not predictable, because human responses to diseases and treatments vary widely. Complications are occurrences that are usually not truly predictable or preventable, even under circumstances where practitioners exercise a high degree of conscientiousness over safety and other patient care considerations. True complications should not be considered errors. Nevertheless, complications sometimes fall within a gray zone that encompasses particular safety factors. Therefore we also need to learn best practices for reducing and preventing complications. www.anamaine.org FALL 2005 PAGE 7 Angel Flight: Increasing Access to Genetic Evaluation, Diagnosis and Treatment by Dale Halsey Lea, MPH, RN, CGC, FAAN E-mail: lead@mail.nih.gov The Release of the New Prescription Monitoring Web Portal Date: To: From: November 1, 2005 All State Licensed Prescribers & Dispensers The Office of Substance Abuse Angel Flight to the Rescue One of the valuable resources that the Genetics and Rare Diseases (GARD) Information Center provides to individuals contacting them for information about genetic and rare diseases is “Angel Flight.” This is a wonderful resource for families in need of transportation to hospitals for medical evaluation, diagnosis, and treatment. Angel Flight is a non-profit grass roots organization with a volunteer corps of more than 6,200 private pilots— divided into six regions across the United States—who fly under the banner of Angel Flight America. Angel flight provides flights of hope and healing by transporting patients in small planes, free of charge, to hospitals for medical evaluation, diagnosis or treatment. Funded by generous individuals, groups, foundations, and grants, Angel Flight flew 38,000 passengers on 18,000 missions. On average, an Angel Flight takes off every 30 minutes from one of thousands of airports and airfields from Maine to California. The counselor and nurse working with the young woman were able to contact Angel Flight and help her to travel to National Cancer Institute for her evaluation and testing. For more information an how Angel Flight may be able to help your patients, go to www.angelflightamerica.org or call 1-800-466-1231. For more information about GARD for your patients go to www.genome.gov/Health/GARD. Accessing Genetic Evaluation, Diagnosis and Treatment: Not Always an Easy Process A young woman, age 35 who had been diagnosed with breast cancer recently sought genetic counseling to learn more about genetic testing options. She had strong family history of early onset breast cancer in her late mother who had died at age 42 from complications related to breast cancer, a maternal aunt who had a history of breast cancer with onset at 40, and her maternal grandmother, who died in her 40’s from breast cancer. The young woman lived on one of the Maine coast islands and was using interactive television (telemedicine) to access the genetics consultation. During the consultation, she told the counselor that she wanted to have hereditary breast/ovarian cancer genetic testing (BRCA1/2) to “see if I have the gene, because this will help me figure out what treatment I want.” Her concern was that she had Medicaid for insurance, and this plan would not cover the $3,000 for the cost of the test. She had been on the Internet and learned about a clinical research protocol at the National Cancer Institute that included BRCA1/2 testing and treatment interventions. She and her family did not have the money to get to Bethesda, Maryland, however. The Department of Health and Human Services, Office of Substance Abuse (OSA), would like to inform the provider community about the development progress of the new web portal for the Prescription Monitoring Program. OSA has been working with the state’s Office of Information Technology (OIT) to develop a portal to give registered prescribers and dispensers real-time access to our prescription dispensing data base so they can monitor patients/customers who may be obtaining dangerous amounts of prescription medication. This new portal would be accessible through the internet making the system more useful to registrants who need the data quickly. Currently, reports are requested by fax, mail, or internet; but returned by only fax or mail. OIT had hoped to be able to release the new web portal by the end of November 2005. Unfortunately, OIT has not been able to stick to this timeline, so the current anticipated release date has been moved back to mid January 2006. The rest of 2005 will be spent finishing the portal and introducing it to rigorous testing to ensure accuracy, efficiency, and usability of the system. OSA will be keeping you all informed of the progress of the new portal as things move forward with development. For other program information please visit our website at: www.maineosa.org/data/pmp If you have any questions concerning the prescription monitoring program or the new web portal, feel free to contact the Program Coordinator, Chris Baumgartner. (207) 287-3363, Chris.Baumgartner@maine.gov PAGE 8 FALL 2005 ANA - MAINE JOURNAL Link to Online Journal of Nursing article on workplace violence McPhaul, K., Lipscomb, J., (September 30, 2004) “Workplace Violence in Health Care: Recognized but not Regulated” Online Journal of Issues in Nursing. Vol. #9 No. #3, Manuscript 6. Available: www.nursingworld. org/ojin/topic25/tpc25_6.htm http://www.nursingworld.org/ojin/topic25/tpc25_6.htm The Pine Tree Chapter of the Infusion Nurses Society The Infusion Nurses Society (INS) granted a charter to the Pine Tree Chapter (PTC) in 1985 and Maine’s connection to the world of infusion therapy continuing education was born. Not all nurses specialize in the field of infusion therapy but, many perform infusion therapy skills during their patient care. The PTC exists solely for the exchange and dissemination of information concerning the latest news and technology in the infusion world. IV catheters alone have become so complex over the last 15 years, that having a group of dedicated infusion practitioners, such as the PTC, has become a grand commodity. The PTC meets 6 times a year in various locations, for a business meeting, an educational presentation, and networking. We also hold a day-long seminar every spring, in Portland. The chapter urges all who work with infusion therapy in any capacity to come to a meeting and become refreshed as to the latest in the infusion specialty. You can contact President Deb Drew, RN, MS at drewd@mmc.org or by calling 207-428-3520. Our next meeting is October 25th at HealthReach, in Gardiner. We start at 6 PM and adjourn promptly by 8 PM respecting the distances some folks have driven. Let the Pine Tree Chapter of INS be at the top of your list when you are seeking answers to infusion therapy dilemmas! Gwen Cole, RN, CRNI PTC President-Elect ABSTRACT Workplace violence is one of the most complex and dangerous occupational hazards facing nurses working in today’s health care environment. This article includes critiques of the conceptual, empirical, and policy progress of the past decade, a discussion of the need for methodologically rigorous intervention effectiveness research, and a description of a joint-labor management research effort aimed at documenting a process to reduce violence in a state mental health system. The development of a typology of workplace violence has advanced our understanding of the relationship of the perpetrator of the violence to the victim and provided a foundation for conceptual frameworks linking etiology and prevention. Even though health care workers may be exposed to four types of violence in the course of their work, the overwhelming majority of threats and assaults against caregivers come from patients (Type II), justifying emphasis on this type of violence. Individual nurses and direct care providers have very little influence over the level of violence in their workplaces, but through collective action are poised to influence policies designed to protect the health care workforce. www.anamaine.org FALL 2005 PAGE 9 Continuing Education Calendar for Maine Nurses We know it will snow, we just don’t know when. ALWAYS CALL AHEAD. Next calendar deadline will be Jan 4th for the issue which will cover Feb through May. Send items to anamaine@prexar.com calendar listings are free. For courses marked USMCCE (University of Southern Maine Center for Continuing Education), call 780-5900 or 800787-0468 or visit www.usm.maine.edu/cce ANA-Maine is the ANCC-COA accredited Approver Unit for Maine. Alas, not all courses listed here are for ANCCCOA credit, but we print them anyway. For CE info anamainece@gwi.net December 9, Augusta, Annual OMNE Legislative update, Ground Round, FMI Donna 207-662-4597 libbyd@ mmc.org December 8 & 9, 2005, Portland, USM Lifeline. ACLS. $165/$235. FMI Cindy at (207) 780-4648 or email: cindymac@usm.maine.edu Dec 12, Portland, Delving Deeper into Death and Dying, 8-4 pm, PESI HealthCare, $169, 800-843-7763 Dec 14 -15, Augusta, 161 Capitol St, Maine State Board of Nursing Meets. FMI (207) 287-1133 NOVEMBER 2005 November 18, Augusta, School Nurse Orientation FMI DeEtte, 624-6688 or deette.hall@maine.gov November 18, Augusta, MHA HQ, Joint MSHHRA/ OMNE Educational Session on the Impaired Healthcare Provider with a focus on nursing. FMI Donna 207-6624597 libbyd@mmc.org November 18, Clinical Update on HIV/AIDS: Issues for Primary Care, 1 p.m.-4 p.m., USMCCE, $55, ANCC November 19, Reiki, Level 2, 9 a.m.-6 p.m., USMCCE, $250, ANCC November 29th, at the Augusta Civic Center, Addressing Issues of Obesity in Maine, sponsored by the MaineHarvard Prevention Research Center. Fee TBA November 29, Portland, 7:00 a.m.-12:00 noon, ADVANCED CLINICAL ASPECTS OF EMERGENCY PREPAREDNESS, Dana Center Auditorium, MMC, no fee, FMI Vicki, 629 9272 or vwills@mcph.org November 30, The Chakra Dance, Exploring Energy, Emotions, and Illness, 9 a.m.-4 p.m., USMCCE, $105, ANCC DECEMBER 2005 December 2nd 0800-1630 Trauma Across the Spectrum MMC Dana Aud, FMI Paulette 662-2397 or walkep@ mmc.org December 2, Lab Analysis and Implications for the Nurse Working in Long-Term Care 1-4 p.m., USMCCE, $55 December 2, Parenting Adult Children: What Empty Nest? 9 a.m.-4 p.m., USMCCE, $95 December 5th 0730-1530 Nursing Research Conference MMC Dana Aud., FMI Chandra 662-6279 or melloc@ mmc.org December 6, Augusta, Civic Center, “Quality Counts! Part 3 Pulling It All Together” MQF highlighting the Chronic Care Model, $50, FMI, Judy Tupper 207-228-8407 jtupper@usm.maine.edu December 8, Augusta. Maine Bureau of Health, Partnership for a Tobacco-Free Maine. Sharing the Journey: A Forum on Women and Smoking, No fee. FMI Kara Ohlund, kohlund@mcd.org or 622-7566, ext. 231; Program content questions: Catherine Ramaika, 287-4628 Dec 8, Portland, OB Emergencies, 8-4 pm, PESI HealthCare, $169, 800-843-7763 December 9, Bladder Control: Mastery at Any Age, 9 a.m.1 p.m., USMCCE, $60, ANCC JANUARY 2006 January 6, 2006, statewide ITV sites: USM, UMA, UMPI, University College, Bangor, Sponsor: Bureau of Health, title: Spinal Screening Training for Maine School Personnel, No cost. FMI : Kara, kohlund@mcd.org or 6227566, ext. 231. For program content or certification questions: Ellen Bridge, RN, BSE, MT, Public Health Nursing, 287-6185 Jan 12 2006, Portland, Critical Arrhythmias, 8-4 pm, PESI HealthCare, $169, 800-843-7763 Jan 16 Abstracts for Maie Nursing Summit in March, due. FMI www.omne.org Jan 26, Portland, Pediatric Palliative Care, 8-4 pm, PESI HealthCare, $169, 800-843-7763 Jan 26, Portland, Maine. The Partnership For A TobaccoFree Maine is sponsoring Tobacco Intervention: Basic Skills Training. The fee is $50.00. FMI: Pam Craig at 207662-5224 or tobaccotrng@mmc.org Jan 27, Portland, MMC Dana Aud., Acute Respiratory Failure & Ventilatory Management, Outreach Education Council FMI Anna 662 2290 or bowdoa@mmc.org Jan 27, Augusta, Follow up to Impaired Nurse, OMNE Ground Round FMI Donna 207-662-4597 libbyd@ mmc.org PAGE 10 FALL 2005 ANA - MAINE JOURNAL Continuing Education Calendar for Maine Nurses FEBRUARY 2006 Feb 6 and 7, Portland, Telephone Triage: 2-Day Conference, 8-4 pm, PESI HealthCare, $169 each day, 800-843-7763 Feb 9, Portland, What You Didn’t Learn in Nursing School: Pearls, Nuggets & Little Bits of Clinical Wisdom, 8-4 pm, PESI HealthCare, $169, 800-843-7763 Feb 10, Augusta, School Nurse Orientation FMI DeEtte, 624-6688 or deette.hall@maine.gov Feb 15—look at your woodpile. You are about halfway through the winter. Do you still have half your cordwood? Feb 17, Augusta, OMNE, Maine’s Nursing Workforce TBD, FMI Donna 207-662-4597 libbyd@mmc.org Feb 18 got cabin fever? Find a contradance. Kick up your heels. Dance til you glow. Go to www.deffa.org Feb 21, Bangor, Mommy I Don’t Feel So Good: Pediatric Problems, Emergencies & Lab Interpretation, 8-4 pm, PESI HealthCare, $169, 800-843-7763 Feb 22, Portland, Mommy I Don’t Feel So Good: Pediatric Problems, Emergencies & Lab Interpretation, 8-4 pm, PESI HealthCare, $169, 800-843-7763 March 17 & 18, Topsham, Down East Country Dance Festival, contradancing, tango, Greek, etc. every nurse needs balance in their life and a there is no substitute for a waltz with somebody you love. www.starleft.org/decdf FMI 993 3108 March 24, Augusta, OMNE hosts Panel discussion with academia and new grads. TBD, FMI Donna 207-662-4597 libbyd@mmc.org March 29, Augusta, Civic Center, 5th Annual Maine Nursing Summit. FMI go to www.omne.org March 30,2006, Augusta, Civic Center, Maine Nutrition Council Meeting, details TBA, FMI www.maine nutritioncouncil.org MAY 2006 May 26, Augusta, Reimbursement for Clinical Performance TBD, FMI Donna 207-662-4597 libbyd@ mmc.org JUNE 2006 Saturday June 3, or Friday June 16 New England Camp Nurse Workshop, at Camp Cedar in Casco, ME. This all day workshop will provide first-time and semiexperienced camp nurses with the tools and skills they will require to have a safe and rewarding camp nurse experience. ANCC-COA. $100 and includes lunch, workbook and materials. FMI, VJ Gibbins at vjgibbins@hotmail.com or 617-277-8080 June 7-8, Augusta, 161 Capitol St, Maine State Board of Nursing Meets. FMI (207) 287-1133 June 22, Rockland, MHA Summer Forum, Samoset Resort, FMI Donna 207-662-4597 libbyd@mmc.org June 2006, ANA national House Of Delegates, Denver Colorado. APRIL 2006 April 12, 2006, Holiday Inn “By-the-Bay” in Portland, I.N.S. Pine Tree Chapter Annual Spring Seminar details TBA. April 8-12, Orlando, FL, AONE Annual Meeting, FMI Donna 207-662-4597 libbyd@mmc.org April 24, Augusta, Annual Maine Nursing Summit, FMI Donna 207-662-4597 libbyd@mmc.org 4/26/06 & 4/27/06, Bangor, Maine. The Partnership For A Tobacco-Free Maine is sponsoring Tobacco Treatment Specialist Training. The fee is $95.00. Attendance of one of the Basic Skills trainings is a prerequisite for enrollment in this training. Contact information: Pam Craig at 207-662-5224 or tobaccotrng@mmc.org MARCH 2006 March 1-2, Augusta, 161 Capitol St, Maine State Board of Nursing Meets. FMI (207) 287-1133 March 1st remember to inspect your chimney for dangerous buildup of creosote. Call your local fire department if you do not know how, they will gladly assist you. March 10, Portland, Pain Management Outreach Education Council, 662 2290 www.anamaine.org FALL 2005 PAGE 11 Tender Living Care (TLC): Providing Loving Support for Families Experiencing Serious Illness A serious illness impacts everyone in a family . . . t is important to recognize that families impacted by serious illness, similar to those who have suffered the death of a loved one, experience grief associated with the changes and concerns that illness brings. Emotional needs are often overlooked or misunderstood because of the pressures and challenges everyone faces when someone in a family is faced with a serious illness. Older children sometimes assume the caretaking of siblings and others, putting their own feelings on hold. Younger children who do not have the words to communicate their questions and fears may construct their own answers, blaming themselves or others for what is happening. Adults want to know what, when, and how to tell children about the illness. The aim of the Tender Living Care (TLC) program is to help children and teens cope with the changes that occur at times of serious illness and help them build strength to meet future loss in their lives. TLC is there to support hope and provide assistance to caregivers in finding sensitive ways of communicating with and guiding children during difficult times. This program also offers support groups for seriously ill children or ill parents. I Anne Lynch, Executive Director for The Center, “and we learn from them every day.” In the Tender Living Care program, families and volunteers begin each Monday evening in the “Opening Circle” room, and then break off into separate age groups. “Children help other children, teens help other teens— facilitated by volunteers,” says Linda Kelly, Program Director, “this is the essence of the peer support model.” The parents also meet during this time to offer support to each other. When children grieve, they often feel the need to protect their parents, hiding their emotions and fears. In their peer groups, they can ask questions or share emotions they might not express outside The Center. In their group rooms there may be tears, laughter, anger, and joy—a whole range of emotions. Art projects, discussion, and creative play are the modes of the evening and provide a catalyst for the expression of feelings. Who put the “whoop” in Whooping cough? The whoop is not always there! Introduction The National Association of School Nurses recently supported a survey that revealed almost 90 percent of polled school nurses are concerned about the recent surge in pertussis (whooping cough) outbreaks among adolescents. In response, NASN launched “Pertussis Tools for Schools,” a campaign designed to educate school nurses, teachers, parents and teens about the signs and symptoms of pertussis. This Adolescent Pertussis edition of the Weekly Digest supports this campaign to increase Tdap vaccination coverage levels for adolescents. Pertussis the disease In addition to the NASN website Tools for Schools information found on http://www.nasn.org look for more disease information on CDC website starting at: http://www. cdc.gov/nip/diseases/pertussis NASN and the Pertussis survey The Center for Grieving Children’s Mission The Center provides loving support to grieving children, teens, families and the community through Bereavement Peer Support, Outreach and Education, and Tender Living Care programs. We honor and encourage the safe expression of grief and loss. We provide a loving community to foster the discovery and development of each child’s own resiliency and emotional well-being. For more information about the Tender Living Care program, please call or e-mail Carol Sylvester, Tender Living Care Coordinator, at (207) 775-5216 or carol@ cgcmaine.org. If you would like to learn more about our Outreach/Education or Bereavement programs, please visit our website: www.cgcmaine.org. Or, call us at (207) 775-5216, email: cgc@cgcmaine.org. The survey that the National Association of School Nurses supported revealed that 75 percent of school nurses surveyed are extremely or very concerned about their students’ susceptibility to infectious diseases. Pertussis is of particular concern, as childhood immunization against pertussis wears off five to 10 years after the last routine vaccination shot, typically administered when children are between four and six years old. Because of this waning, many adolescents are vulnerable and unprotected against this serious disease. The Peer Support Model Tender Living Care, a program of The Center for Grieving Children, is founded on the principle that grief is a natural response to loss and change. Our role is to provide a safe environment for the healthy expression of feelings in order to foster resilience and strengthen a child’s emotional intelligence. Everyone’s grief is unique. We believe when given a safe place to express feelings, children, teens, and adults have the ability to heal themselves. “We honor the wisdom of children,” says Pertussis outbreaks guidelines Publication updates in Jan.2005. “Guidelines for the Control of Pertussis Outbreaks.” Chapter 8. School and childcare settings. From the National Immunization Programs, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. http://www.cdc.gov/nip/publications/ pertussis/guide.htm PAGE 12 FALL 2005 ANA - MAINE JOURNAL Fight Crime Dot Org by Mary Small, Executive Director, Brunswick, Maine n the early 80’s, while I served in the Maine House, there was a singularly heinous act of child abuse that resulted in the death of a 4-year-old girl. That incident so outraged the public that the Legislature and the Governor had a prime opportunity to enact legislation and increase child welfare funding to try to prevent this from happening again. Most of the Legislature’s efforts, while well intended, focused on adding caseworkers and dealing with the child after the abuse was discovered or reported. I often wish we had known then, what we know now; that much of the abuse and neglect can be prevented. It is thanks to nurses and the successful Nurse Family Partnership program that we have compelling research that shows us that prevention programs really do work to decrease child abuse and neglect. Effecting Positive Change in Patient Safety/Advocacy The American Nurses Association is working as a strategic partner with the Institute for Healthcare Improvement (IHI) in the Saving 100,000 Lives Campaign, which aims to educate nurses and others on ways to enhance patient safety in the hospital setting. This breakthrough campaign provides a unique opportunity for nurses to make an impact in effecting positive change in patient safety/advocacy at individual hospitals and across the nation. When clinicians work together, great things are accomplished. ANA is looking for nursing leaders to get hospitals and nursing staff involved in the campaign, which consists of evidence-based interventions to improve quality and patient safety. Hospitals can implement any or all of the programs, including: • Deployment of Rapid Response Teams (that include nurses) • Delivery of Reliable, Evidence-Based Care for Acute Myocardial Infarction • Prevention of Adverse Drug Events (ADEs) • Prevention of Central Line Infections • Prevention of Surgical Site Infections • Prevention of Ventilator-Associated Pneumonia Over 2500 hospitals throughout all 50 states and the District of Columbia have already signed on. Nursing involvement directly supports ANA’s Patient Safety/Advocacy strategic imperative. By effecting positive change around issues that are so critical to nursing and its future, ANA is advancing its ultimate goal, patient safety and quality nursing care. I showed that children of mothers left out of the program were five times more likely to be abused or neglected than children of mothers who received services. The Nurse Family Partnership program also cut crime. Compared to the children whose mothers received parent coaching, the children from families not in the program had twice as many arrests by the time they were 15 years old. The parent coaching not only saved lives, but money as well, saving taxpayers four dollars for every dollar invested. Survey of Maine Maine has made great strides to provide in-home parent coaching services to new mothers through its Healthy Families, Parents as Teachers, and Parents Are Teachers Too programs in addition to the public health nurses that provide these critical visits to families in need. An evaluation of these programs revealed they are increasing immunization rates well above the state average, and that well-child visits and child insurance coverage rates are also high. The programs are helping to find children with developmental delays and enroll them in services. They have helped over 7 percent of all mothers who smoked to stop smoking and have either helped stop or lower the exposure of nearly two-thirds of the children to secondhand smoke. Although in-home parent coaching programs are now located in every county in Maine, due to inadequate funding only about half of all first-time mothers are offered services and many at-risk families are falling through the cracks. Every year, as many as 2,000 mothers getting ready to give birth for the first time in Maine cannot access parent coaching services. The state cannot afford to improve the quality of the services offered and reach more new mothers without new federal investments. That is why our law enforcement members are working to secure funding from Congress for proven prevention programs that will help stop the abuse before it starts. As is the case with most prevention, the investment up front saves many dollars and lives down the road. Unfortunately, with so many competing needs for funding, prevention is not always a top priority. Statistics on Child Abuse and Neglect in Maine As Maine state director for the national crime prevention organization Fight Crime: Invest in Kids, I work with law enforcement members who are steadfast in their support for programs that keep children from being abused and, as they have seen all too often, growing up to become the abusers. The statistics are hard to hear and even harder to deal with. On average, 13 children will be abused or neglected every day in Maine. Eighteen Maine children died from abuse or neglect in the six years from 1998 to 2003. In 2003, more than 4,700 children in Maine were officially confirmed as abuse and neglect victims, but the best estimate of the actual number of kids abused or neglected is three times higher. Unfortunately, these cases are so prevalent that most Maine law enforcement officers have responded to at least one during their careers. As our law enforcement members see firsthand, child abuse and neglect is not simply a crime against innocent children—it is a problem that breeds future generations of criminals. Last November Fight Crime: Invest in Kids unveiled a comprehensive report entitled Protect Kids, Reduce Crime, Save Money: Prevent Child Abuse and Neglect. The report documents the toll on children and crime if abuse and neglect is not prevented. It shows that poor mothers who had been abused or neglected as children were 13 times more likely than mothers who were not abused to abuse their own children. Based on the most recent child abuse and neglect statistics, Fight Crime: Invest in Kids Maine calculates that of the confirmed 4,700 abused and neglected children in Maine, as many as 188 will become violent criminals as adults because of the abuse and neglect they endured. Learn More, Download the Effecting Positive Change in Patient Safety Toolkit ANA has developed educational materials to help nurses get hospitals involved in the campaign. Download the Effecting Positive Change in Patient Safety Toolkit, posted in PDF format, which provides step-by-step instructions on how to get started. Let’s work together to prevent child abuse Nurses play a key role in the detection and treatment of abuse and neglect and it is no surprise that, on the state and national front, they are also playing a major role in promoting prevention. I am asking Maine nurses to join with the law enforcement members of Fight Crime: Invest in Kids and help get the message to Congress that the federal government needs to help states fund successful prevention strategies to prevent child abuse. Maine is heading in the right direction but without federal funding, we will never be able to reach all the families and children that so desperately need help. As we work to build a coalition to ensure child abuse prevention becomes a national budget priority, I hope Maine’s nurses will assist us to educate our leaders that prevention does work. If you are interested in showing your support for federal child abuse prevention funding, please contact me at maryesmall@fightcrime.org or 207-443-8880. Is Your Hospital Already a Participant? Complete the Effecting Positive Change in Patient Safety Questionnaire If your hospital is already participating, complete the questionnaire to let ANA know more about the activities and especially how nurses are involved as leaders. ANA is a strategic partner in the Institute for Healthcare Improvement’s Saving 100,000 Lives Campaign and invites you to share your activities. Share success stories ANA encourages nurses to share stories about Saving 100,000 Lives Campaign successes. http://www.nursing world.org/patientsafety/ (editor’s note: nearly all Maine hospitals have signed on to the IHI initiative. We have heard anecdotally that the Rapid Response Teams, in particular, have been beneficial. We would be interested to publish more as to these teams and what works best. Send to anamaine@prexar.com) In Home Parent Coaching Programs are effective Sad as these facts are, the opportunity to save many defenseless children from abuse is well within our grasp. We know, for instance, that in-home parent-coaching programs can prevent most abuse and neglect in high-risk families, and decrease the chances of children becoming criminals. Parenting is a tough job, especially if you have not done it before or had less than model parents from which to learn your parenting skills. It is a simple but proven idea that some help for parents, before and in the early period after a child’s birth, will reap huge benefits. Research has confirmed that these programs can cut child abuse and neglect by as much as 80 percent. The program that has the best research available is the Nurse Family Partnership, a model program in which nurses provide parenting coaching and other skills to at-risk new mothers, starting before their babies are born. A rigorous study www.anamaine.org FALL 2005 PAGE 13 Health Alert from the BOH-FYI 2005PHADV064 Dora Anne Mills, M.D., M.P.H., Public Health Director Preparing for Influenza, 2005-2006 September 26, 2005 Preparing for Influenza, 2005-06 Maine Health and Human Services’ Public Health 2. We recommend that all medical providers now post information on preventing influenza, including strategies such as hand-washing, covering coughs, and staying home if ill. Posters are available for downloading and printing on our website (mainepublichealth.gov). 3. We encourage all eligible health care professionals under age 50 to consider taking live flu vaccine (Flu Mist) now. Recommendations 1. Maine HHS Public Health and the CDC recommends that only the following priority groups receive trivalent inactivated influenza vaccine before October 24, 2005: • Persons aged >65 years with comorbid conditions; • Residents of long-term care facilities; • Persons aged 2-64 years with comorbid conditions; • Persons >65 years without comorbid conditions; • Children aged 6-23 months; • Pregnant women; • Healthcare personnel who provide direct patient care • Household contacts and out-of-home caregivers of children aged <6 months All others desiring flu vaccine should be able to receive vaccine after October 24, 2005. For More Information For more information on flu vaccine provided by Maine HHS Public Health, please call 1-800-867-4775. To report suspect cases of Influenza or for Medical Epidemiology consultation, please call 1-800-821-5821 (24-hour line). www.mainepublichealth.gov for Maine-specific and national information on flu vaccine as well as posters www.cdc.gov/mmwr/preview/mmwrhtml/mm5434a4.h tm for CDC information on flu vaccine http://findaflushot.com/ for the schedule of some public clinics being held in supermarkets and pharmacies in Maine Maine Vaccine Supply and Distribution We do not anticipate a shortage this year of influenza vaccine. Three manufacturers are currently licensed to provide inactivated (injectable) vaccine, and another one is licensed to provide live nasal flu vaccine. Two injectable vaccine products were just recently licensed. There is a delay in some vaccine being shipped. Three main channels through which vaccine is distributed in Maine: 1. Maine HHS Public Health uses some of Maine’s share of the National Tobacco Settlement and Federal CDC funds to purchase flu vaccine and distribute it for free to health care providers for atrisk pediatric and adult populations. We anticipate shipping about 140,000 doses, though most of our vaccine is not expected to arrive until October or November. More information on ordering flu vaccine with us is available at the Maine HHS Public Health’s Immunization Program at 1-800-867-4775. 2. Some health care providers order vaccine privately from distributors or manufacturers. We understand vaccine is available through this channel. For more information, our Immunization Program has a list of Maine flu vaccine distributors (1-800867-4775). 3. Many in the public obtain flu vaccines through private businesses and employers. A private company is planning to conduct flu shot clinics in Maine again this year at supermarkets and pharmacies, starting October 1st. We understand they will provide vaccine for only high-risk people until 10/24/05. The cost is $25 per vaccine, and is covered by Medicare. A schedule of these clinics can be found at http://findaflushot.com/. Hotel 66 A Maine Nurse at Walter Reed h, springtime in Washington County! It was March 23, 2003 and the snow was beginning to recede. The hope of “mud season” was near. I had just finished a quiet shift in the Special Care Unit at Down East Community Hospital when the phone rang. “You have been mobilized for a year of active duty. Please report to Walter Reed Army Medical Center (WRAMC).” As an Army Reserve Nurse, I know this call can come at any time. So I packed up my little truck and it was off to Washington! The War in Iraq had just started. WRAMC was in full swing, accepting wounded soldiers from both Iraq and Afghanistan and maintaining services to veteran soldiers from previous conflicts. The critical care units were full. Much of the active duty military staff was being sent to Iraq to the field hospitals there. I am a critical care nurse. Our mission was to “backfill” the critical care nurses at WRAMC who train to staff the combat hospitals. As they deploy to Iraq, we “66 Hotels” (that is army talk for critical care nurse) slide into the ICU positions. We hit the long WRAMC corridors running! Wounded soldiers who were briefly stabilized in overseas Army hospitals were evacuated by air to Walter Reed. They were transported to a central triage area. For several months, this was a nightly occurrence. Every nurse rotated through this area. Here we triaged, re-assessed wounds and injuries and placed soldiers in the appropriate unit of the hospital. While our role here was serious and conducted in a most professional manner, it was not without its lighter moments. One young soldier with multiple fractures had an IV “blow” on the long flight to Walter Reed. As I was setting up to start a new one, he confided to me in a shaky voice that he was “very afraid of needles, ma’am!” Looking at him lying there on the stretcher, so far from home, I must admit I slipped into “mother mode.” “It will be alright,” I told him gently. “I am going to numb the area first, then slip the IV catheter in. Let’s take your tee shirt off, so the doctor can examine your wounds.” The shirt was removed to reveal TATOOS all over his arms, back and chest! Most of our hours were spent in the critical care units. There is a Surgical ICU, Medical ICU and a CCU. Here we A cared for soldiers severely injured during the conflict. I was absolutely amazed at the ability of the Forward Army Surgical Teams (FAST units) to save the lives of our soldiers. One soldier had an IED (Improvised Explosive Device) hit his side and cause severe damage under his protective clothing. He had had thoracic surgery in the field during which he was transfused many, many units of blood. The night I cared for him he was on the ventilator and had five chest tubes. (I may be wrong, but since I have been at Down East Community Hospital (DECH), I don’t think we’ve ever had five chest tubes in the entire population at one time!) As morning approached and we were preparing to extubate him, he kept pointing to his head. I racked my brain to figure out what he needed. Headache? An unnoticed laceration? Once extubated, he asked me to wash his hair as the Vice President was coming that day to give him a medal! Ah . . . hair washing. Do you have the right nurse! At DECH we try and make our folks as comfortable as possible and do a lot of hairwashing! The patient population at WRAMC was comprised of veteran soldiers as well. I was privileged to care for a 95year-old Colonel in the Army Nurse Corps who had been in charge of all the nurses in the Pacific Theater in WWII. I also cared for a veteran of the Bataan Death March. I asked him how he survived, when thousands died during the march, in captivity or on the unmarked carriers that were bombed as they returned home. He had a sling shot during the march and kept alive by shooting small birds. “I was a terrific shot” he told me. I was at WRAMC thirteen months. When I returned home, the question I was most frequently asked was “Did I see Jessica Lynch?” No. Jessica topped the long list of people I did NOT see while at WRAMC. I did not see the President or Vice- President. I did not meet Michael Jordan, Ricky Craven, Cher or Mel Gibson. They were all there. I was probably asleep! Who I did meet were many brave soldiers and dedicated military medical staff who worked unbelievably long hours without complaint. It was an experience this “66 Hotel” will always remember. Diane Raymond, RN, BSN, CCRN works at Down East Community Hospital in Machias. She is still a reservist in the Army Nurse Corps. The views expressed are her own. Ms Raymond has been a nurse for 31 years. She says she is older than dirt. draymond52@earthlink.net PAGE 14 FALL 2005 ANA - MAINE JOURNAL Finding Reliable Genetic Information for Individuals and Families: A Critical Nursing Role Dale Halsey Lea, MPH, RN, CGC, FAAN, Health Educator, Education and Community Involvement Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD diseases. The requests include many inquiries from physicians, nurses and other health-care professionals, as well as patients and patients’ families directed to the site by health-care professionals. To date, most users have contacted GARD by e-mail, GARDinfo@nih.gov, or by calling the toll-free telephone: (888) 205-2311 or TTY: (888) 205-3223, which are answered from noon to 6 p.m., Monday through Friday. Requests can also be sent to GARD by fax: (240) 6329164; or by mail: P.O. Box 8126, Gaithersburg, MD 20898-8126. People requesting information receive a response from GARD within four to seven business days on average. However, depending on the nature of the inquiry, the turnaround time for inquiries from health-care professionals often is much faster. For example, an urgent request may receive a response within 24 hours or even immediately. However, GARD’s success is reflected by far more than statistics. Health-care professionals who have taken advantage of the services offered by the center have responded enthusiastically. In the words of one physician: “Thank you very much for the information, which is very helpful—the genetic terminology doesn’t bother me too much—just takes me back to my student days.” Feedback from health-care professionals plays a critical role in GARD’s ongoing effort to fine tune the services that it provides. For example, based on comments from some of its initial users, GARD now offers even more comprehensive responses with greater detail on locating information resources than when the center first opened. “You have started me in the right direction and helped me greatly as I have not been able to find any information about this disorder to date,” wrote one health-care professional, adding, “I will share this information with my client’s maternal grandmother and foster mother.” GARD information specialists provide inquirers with current, accurate and authoritative information by drawing from public domain sources, including reliable Web sites, brochures, articles and organizations. While patients and their families often contact GARD seeking direct referrals to health-care professionals or asking for treatment or medical management suggestions, it is important to emphasize that GARD does not directly provide this type of information. Instead, GARD information specialists direct the inquirer to resources that might give treatment information, e.g. journal articles or clinical trials. GARD also does not provide genetic counseling or offer diagnostic testing, but will point the inquirer to appropriate sources of information about such services. GARD views itself as working in partnership with the health-care community, always strongly recommending that patients seek the advice of their own health-care providers with any questions regarding their medical care. That collaborative approach has drawn praise from one nurse who turned to GARD for answers: “What I like best is how generous you are in your links to other Living in a Family with a Rare Genetic Condition When I was in my senior year of high school, I began to notice that my mother’s memory was not what it used to be. At 42 years old, she was forgetting things like where she parked the car, or that she was supposed to pick me up at school. She repeated the same questions to us. Over the next 8 years, my sisters and I watched a gradual decline in her mental functioning, which she denied. We finally persuaded her to have an evaluation at a major hospital. I remember the neurologist showing us the CT scan that showed cortical atrophy, saying, “Your mother has Alzheimer Disease. She will continue to deteriorate and then die. There is no treatment or cure for this.” And then we went home. We didn’t even know what Alzheimer Disease was, and when we did learn from looking in her brother’s medical textbooks, we couldn’t believe that it was happening to our mother at such a young age. We had no support in the late 1960’s and 1970’s as we lived through our mother’s eventual placement in a nursing home and death at age 54. We had no support, no one helped us find information, when her brother, a successful orthopedic surgeon, developed the same symptoms in his 50’s and died in his 60’s. organizations, which I think communicates concern for the person. As a nurse, I also like the advice encouraging people to consult a professional. I appreciate your response!” In addition to furnishing health-care professionals with accurate, up-to-date information on genetic and rare diseases, GARD can also serve as a timesaving tool to help such professionals reinforce or expand upon genetic and rare disease information that they may have already provided to patients. One patient who used GARD’s services sums it up in this way: “Thank you so much for your help and the additional resources that you’ve listed. So many times, sad news is shocking and we cannot or do not remember the advice the doctors gave us. I appreciate your time and effort.” Nurses Role in Providing Reliable Genetic Information Nurses are present throughout the healthcare system, and care for families throughout the lifespan. Nurses are often the first health care professional to whom individuals turn with questions about a new genetic diagnosis or concern. It is my hope that nurses today will take advantage of the GARD Information Services to educate themselves and provide reliable genetic information to those individuals in need, so that they will not feel so alone in their journey with a genetic condition. How to Contact GARD Information Specialists are available from 12 noon to 6:00 p.m. Eastern time by: • Telephone: 888-205-2311 • TTY: 888-205-3223 • FAX: 240-632-9164 • E-mail: GARDinfo@nih.gov • Mail: P.O. Box 8126 Gaithersburg, MD 20898-8126 Additional GARD information can also be found at: • National Human Genome Research Institute (www.genome.gov/Health/GARD) • Office of Rare Diseases (http://rarediseases.info.nih. gov/html/resources/info_cntr.html) Meeting the Genetic Information Needs of the Public Today, we are living in an information age with the Internet widely available and used by the public to locate information and services. We are also living at a time when the entire human genome has been mapped and sequenced. New genetic tests are becoming available to screen and diagnose individuals for both rare and common diseases. There are more than 7,000 rare diseases, and many more common diseases such as cancer, heart disease, and diabetes that have a genetic basis. A disease is considered rare if fewer than 200,000 people in the U.S. have it. Today about 25 million Americans have a rare disease. Many rare diseases are caused by changes in genes and are called “genetic diseases.” New gene-based treatments are being used for breast and other cancers. These new advances in genetic-based prevention, screening, and treatment create challenges for individuals and families who have or who are at increased risk for common and rare genetic conditions. How can they find reliable and understandable genetic information when they have a newborn with a metabolic condition identified by newborn screening, a child with a new genetic diagnosis, or a parent with early onset colon cancer? Genetic and Rare Diseases Information Center Keeping pace with the ever-expanding body of scientific knowledge about genetic and rare diseases can be an uphill battle for many health-care professionals. Even for those who manage to stay abreast of the latest developments, a major challenge remains: finding the time and resources needed to clearly convey such information to patients and their families. Now, the National Institutes of Health (NIH) is offering health-care professionals free assistance on both fronts in the form of its recently established Genetics and Rare Diseases (GARD) Information Center. Funded by the NIH’s National Human Genome Research Institute (NHGRI) and the Office of Rare Diseases (ORD), the center provides health-care professionals and their patients with immediate access to experienced information specialists who can furnish current and accurate information about more than 6,000 genetic and rare diseases. Since it was established in February 2002, GARD has responded to nearly 4,000 inquiries on rare and genetic www.anamaine.org FALL 2005 PAGE 15 MHA Reaction to Editorial on Safety Star Program The following Opinion Editorial appeared in the Oct. 14, 2005, edition of the Kennebec Journal. by Steven R. Michaud, President, Maine Hospital Association The newspaper’s editorial of Sept. 21 reports that hospitals “had better have a good answer” for not participating in the state’s new Safety Star program. Besides its hostile and threatening tone, this statement also shows profound ignorance as to how Maine hospitals already rate in the quality of care they provide and what they are continuing to do as they pursue quality excellence. (hospitals) would not participate in a program that recognizes hospitals for safe practices.” Nor can we. Even before the Safety Star program was launched, Maine hospitals reported quality indicators to a dizzying array of organizations, including the federal Centers for Medicare and Medicaid Services, the Joint Commission on Accreditation of Healthcare Organizations, the Maine Health Management Coalition, the Maine Hospital Association and the Maine Quality Forum. All of the organizations I have just listed have a public reporting component. In fact, the Maine Quality Forum already requires that hospitals report on more than 50 measures. And if that were not enough, earlier this year the Maine Hospital Association joined an effort sponsored by the Institute for Healthcare Improvement’s 100,000 Lives Campaign, which focuses on improving patient care. Maine Hospitals currently ranked third in Nation by federal government In two recent studies conducted by the federal government and published in the Journal of the American Medical Association, Maine hospitals rated third-best in the nation on the quality of care provided to Medicare patients. But Maine hospitals do not rest on that stunning achievement. They continue to pursue excellent quality and assure patient safety without being asked or required to by the state or anyone else. Maine hospitals have been at the forefront of evaluating, improving and reporting the quality of care they provide. In the areas of heart-attack and heart-failure treatments, Maine hospitals overall scored in the top 16 percent of the hospitals in the federal government database. And in patient satisfaction, Maine hospitals scored above the norm 191 times in 16 categories. The newspaper writes that it “cannot imagine why Should Maine hospitals pursue every quality ranking? We believe it is more than obvious that Maine hospitals already excel and continue to pursue excellence in the area of quality care. However, before the newspaper suspects that hospitals might “dodge” a program such as Safety Star, it is important to note there might come a point of diminishing returns in participating in every initiative that comes down the road. Participating in a particular program and its specific requirements and interpretations might divert vital resources away from areas that actually will improve patient care. We wish hospitals in Maine could say without hesitation they have the resources to participate in every quality-reporting program that comes along. But we need to take into account that many of these are redundant, with administrative burdens that are crushing. Hospitals have an equal responsibility to ensure that the quality care they deliver is affordable. Needlessly increasing administrative costs is hardly consistent with the goals of affordable health care. We believe state government and this newspaper should allow hospitals to make that judgment and to be deliberative as to how they spend precious resources. We are also surprised the newspaper would unilaterally assume that a quality program started by state government should automatically be held in such high regard. The state of Maine has its own hospital here in Augusta that functions under a 15-year-old court order and court takeover of the state’s management of that hospital because of poor quality and safety. Are we now to assume state officials should sit in judgment of the quality and safety in Maine’s 39 hospitals that are communitygoverned and that are ranked third in the country? State and federal money that cannot be accounted for, computer system debacles and the inability to pay health-care providers on a timely basis only scratch the surface of the quality problems within state government itself. Hospitals have to make tough choices. We support the goals of the Safety Star Program, and many of our members may participate. Our hospitals practice the standards that the program will measure. But some might choose to direct the focus of their safety efforts to programs they already participate in, and they should be proud to do so. Consumers should not assume that lack of a star from state government means unsafe or poor quality just because state government and newspapers lead them to believe so. Steven R. Michaud of Topsham is president of the Maine Hospital Association in Augusta. PAGE 16 FALL 2005 ANA - MAINE JOURNAL Mayo Regional Hospital by Tom Lizotte DOVER-FOXCROFT—No hospital is immune to the effects of the national healthcare labor shortage, which continues to see vacancy rates of up to 15% in some nursing and health occupations. Yet Mayo Regional Hospital in Dover-Foxcroft has fared better than many hospitals in its recruitment and retention of employees, thanks to a four-pronged strategy that emphasizes facility modernization, competitive wages and benefits, patient satisfaction and employee satisfaction. Mayo’s facility expansion, an $8.5 million construction and renovation project, transformed the hospital campus after its completion in 2003. Although designed primarily to improve the quality and confidentiality of patient care, it has also helped boost employee satisfaction by providing staff with a state-of-the-art facility in which to deliver that care. Healthcare providers welcome the opportunity to work in new Emergency Department, obstetrics and surgical areas, as well as renovated space for radiology, cardiopulmonary services, physical therapy, medical information and patient registration. Mayo administrators feel that employee satisfaction also translates into patient satisfaction with the quality of care. And satisfied patients are most likely to return to Mayo for future care, providing the hospital with the financial stability it needs to improve and expand programs and services. “High-performing hospitals maintain strong links to both employees and patients,” said Ralph Gabarro, Mayo’s Chief Executive Officer. “We believe that positioning Mayo as both the employer of choice and healthcare provider of choice for the Penquis region is both an important priority and a means to strengthen our performance.” To measure its progress toward those related goals, Mayo has contracted since 1999 with Avatar International, a company that specializes in improving customer service. Avatar conducts employee and patient satisfaction surveys for Mayo, and the hospital uses the survey data as the basis for promoting the continuous improvement of patient care and the employee work environment. Gabarro said results from the Avatar surveys place Mayo at the highest rank of both patient and employee satisfaction for hospitals in the United States. Mayo’s employee satisfaction results, coming from a survey of employees last year, are especially noteworthy. Avatar measured 18 outcome areas designed to reveal employee perceptions on all aspects of work at Mayo, and employees identified all 18 areas as Mayo “strengths.” Avatar ranked Mayo’s employee survey results above the 98th percentile. Ken Proctor, Mayo’s Director of Human Resources, said the hospital conducts the organization-wide employee opinion survey every other year, seeking staff feedback on ways to improve employee satisfaction and productivity. Administration analyzes the results of the survey and implements initiatives that are responsive to concerns identified by employees. Proctor said that to ensure Mayo’s wage and benefit plan remains competitive, the hospital conducts an annual wage/salary review and adjusts pay grades where appropriate. In addition, the hospital frequently assesses its benefits package, and has added an annual longevity bonus that rewards long-term employees for their dedication to Mayo. Mayo has formed a Recruitment and Retention Committee to develop new workforce strategies. That effort has paid off—Mayo has lowered its employee turnover rate significantly. “Our primary goal is to retain our existing employees. That is so important in a tight labor market,” said Proctor. Mayo has also implemented a loan/scholarship program that is designed to assist current and future nursing and other eligible health care students with expenses associated with their education. Proctor said the program offers loans up to $10,000 over a four-year period to qualifying students. Loans are forgiven at specified rates for each year that students work at Mayo after graduation. “At the same time, we are also assisting health care professionals with outstanding student loans that they have acquired on their own. This program offers payment toward qualifying educational loans for RNs and other eligible health professionals who come to work at Mayo Regional,” said Proctor. The hospital makes payments on such loans at a specified rate for each year that an eligible candidate is employed at Mayo, up to $10,000 over a fouryear period. Those changes are in addition to efforts Mayo already makes toward employee development: a generous tuition reimbursement program, on-site training, access to telemedicine training for statewide events, and opportunities for nurses to cross-train to specialty units. Proctor said Mayo acted to increase the nursing retention rate five years ago when the hospital eliminated the practice of sending nurses home involuntarily during periods of low patient census. Mayo now guarantees nursing hours, giving staff more time during low-census periods to pursue self-development and processimprovement activities. “This has improved staff scheduling and really increased employee satisfaction among our nurses because it is less disruptive to their lifestyles,” said Proctor. Mayo has long maintained a progressive wage and benefit package that includes time and a half for call back pay, an employer match retirement plan and fully paid health insurance for individuals. The hospital administration also instituted a goal-sharing program as a result of employee feedback. Under this program, employees share a pool of funds at the end of a fiscal year when the hospital reaches targeted goals for patient satisfaction and overall financial performance. (Tom Lizotte is Director of Marketing & Development at Mayo Regional Hospital) www.anamaine.org FALL 2005 PAGE 17 S H O R T S Ability Maine’s Newest Online Guide Taking Control: Living with a Disability Ability Maine is an online disabilities information resource for and by people living with disabilities (PWD) in Maine. Check out. http://www.abilitymaine.org/guides/newhome.html. FMI call Russ at 207-832-4754 January 17-April 18, 2006. Class meets 2 days per week. lecture day: Tuesday 8:30 AM-4:00 PM clinical day: TBA (8 hours). Cost including books: $750.00. Your application must be received no later than January 3, 2006, Please contact Susan Baltrus-Course Coordinator-at (207) 7952846 or e-mail to baltruss@cmhc.org. this experience shall have been within the five years prior to initial application for the certificate. A conditional certification can be obtained if the candidate does not hold a bachelor’s degree. In that case, the candidate must be matriculating into a bachelor’s degree program for an accredited college or university. A maximum of five conditional school nurse certificates may be issued to an applicant. Each conditional certificate lasts for one year. Med administration in schools lllllllllllllll Sigma Theta Tau International, Honor Society of Nursing Call For Abstracts 8/22/05 The 17th International Nursing Research Congress, 2022 July 2006 is accepting abstracts. It will take place in Montréal, Quebec, Canada. Suggested topics, criteria for rating submissions and abstract submissions are available at www.nursingsociety.org/events/17_INRC_call.html. Abstracts must be submitted through the online submission system. If you have any questions, please email research @stti.iupui.edu. lllllllllllllll Buddy Program Update lllllllllllllll The revised Instructor’s Manual for the Medication Administration training and the Handbook for unlicensed school personal is now on the School Health Manual web site. Also available is the new MRSA section. You can find these at www.maine.gov/education/sh/contents.htm. ONLINE TOOLKIT PROVIDES RESOURCES FOR CREATING SAFE SPACE FOR ALL YOUTH Creating Safe Space for GLBTQ Youth: A Tooklit contains lesson plans, tips and strategies, and other resources to help youth-serving professionals create a climate in their organizations that will make young people of all sexual orientations and gender identities feel safe. Intended for use by service providers in building knowledge and understanding and taking action for social justice, the toolkit is available at http://www.advocates foryouth.org/publications/safespace lllllllllllllll Tender Living Care, A Program of Hope and Healing for Families Affected by Serious Illness Monday evening peer support groups for children ages 3-18, care giving adults, children with illness, and adults with illness. Community outreach including; telephone support, educational materials, visits and/or presentations to schools, community organizations, conferences, and businesses. A new peer support session is beginning soon, please call or email Carol at (207) 775-5216 or Carol@cgcmaine. org. lllllllllllllll The second session of the legislature is likely to address issues of Savings Offset Payments (another new tax on hospitals), “tax and match” ( an old tax), the continued problems with the state computer system to pay providers, revisiting the cost cap that limits nurse’s wages in hospitals, the wage scale paid to CNAs in nursing homes, the gastronomy tube issue, whether we want a “pay for performance” system, how to use the Nursing-sensitive indicators in a non-punitive way, and a variety of other issues. When you read this list, ask yourself if your nursing practice could be impacted by decisions made in Augusta. Then send us your email address ( home emails only please, and if you have aol, be sure to add us to your list of accepted senders). Gather a network of other nurses in your workplace and arrange to forward any email alerts you get from us. Our senators and representatives need to know that their decisions will have a practical impact. They may not listen to lobbyists, but they will listen to people from their own district. All nursing issues are bipartisan. Our patients are counting on us! Perioperative Course in Lewiston, Maine lllllllllllllll 2006 Nursing Summit March 29 lllllllllllllll Are you a Registered Nurse interested in developing skills to enter into the practice of perioperative nursing? This course will prepare you to practice in the areas of preassessment, operating room, and post anesthesia care. Wanna be a school nurse? lllllllllllllll In August 2005, the Department of Education’s certification rule for Maine School Nurse Certification was changed. The requirements are now: 1. Holds a valid Maine license as a Registered Professional Nurse; 2. Earned a bachelor’s degree from an accredited college or university; 3. Completed a minimum of three years of experience as a nurse. At least 1 year of Each spring there is a “Nursing Summit” to discuss policy issues in Maine. If you or your agency have done something innovative that you wish to share, you can be a presenter. The deadline for the abstract ( a summary of your project) Is January 16, 2006. go to www.omne.org to get more info. Trivia Question? How many actively-licensed RNs are there in Maine? Eighty per cent of Maine’s nurses are located in just five counties . . . can you name which five? Send answer to anamaine@prexar.com PAGE 18 FALL 2005 ANA - MAINE JOURNAL State Still Owes Hospitals State Underpayments Threaten Quality, Access by Rebecca Schnur, Maine Hospital Association. $310 million. That’s how much the State of Maine will owe Maine hospitals in past debt and underfunding of current payments to hospitals by the end of the biennium.” The State’s chronic underpayments to hospitals threatens the quality and scope of care those hospitals provide. Every dollar of care hospitals provide to MaineCare patients that isn’t reimbursed by the state is a dollar that hospitals can’t spend on meeting the health care needs of their communities. Maine’s hospitals provide quality health care 24 hours a day, seven days a week to all patients regardless of their ability to pay. Maine’s hospitals have stepped in to bridge gaps in access to services to ensure access to primary care physicians and specialists, to provide access to continuing care services, mental health services, nursing facilities, and public health programs. But hospitals’ ability to maintain their missions is continually jeopardized by the significant under funding of the MaineCare program. This program is vital to ensuring that the neediest Mainers, both children and adults, receive the care they need when they need it. MaineCare must be preserved to ensure the health of our most vulnerable citizens, but such preservation must be done by fairly covering the cost of providing high quality care to the program’s patients. suffering from diabetes, heart disease and asthma. Hospitals cannot continue to offer these programs when they are losing millions of dollars because of the state’s failure to pay what it owes. This at a time when the state is demanding that hospitals reduce their costs. This at a time when the State is establishing a state health plan with the goal of making Maine the healthiest state in the nation. The underpayments force hospitals to borrow money to meet payroll. Instead of spending money on new technology, like physician order entry systems, hospitals have to set aside money for interest payments. When the state doesn’t pay what it owes, hospitals can’t invest in the latest diagnostic equipment, open a new pediatric office or hire more visiting nurses. Maine’s hospitals are committed to treating everyone, regardless of ability to pay. Hospitals are the health care safety net, there 7 days a week, 24 hours a day. Hospitals are also bridging significant gaps in Maine’s healthcare delivery service by providing access to vital services–gaps created as many healthcare providers find themselves unable to continue to provide care to MaineCare beneficiaries because of poor MaineCare reimbursement. The goal for the MaineCare program must be to ensure access to the right care at the right time and in the right setting. For this goal to be reached, the state must pay its bills. (editor’s note: ANA-Maine is opposed to budget cuts that are outside of a rational planning process that takes into account the needs of the patient and the care delivered. Funding issues are critical to the health of Maine’s hospital system.) MaineCare Expansion No one knows more than the people who work at hospitals the cost in human suffering that putting off medical care can cause. Hospitals want people to receive the right care in the right place at the right time and health insurance coverage, be it public or private, helps ensure that. Over the last few years, the Maine Legislature has supported several expansions of the state’s MaineCare program to allow more people in Maine access to MaineCare benefits. At the same time that the state has expanded access to the MaineCare program it has failed to keep pace with the increasing demands on the state budget to care for these individuals. What is a PIP? MaineCare pays hospitals a set amount every week, called a Prospective Interim Payment or PIP. The state estimates how many MaineCare patients a hospital will care for and pays that hospital based on that estimate. When the state expanded MaineCare, it didn’t increase the PIPs to hospitals to account for the additional patients they were seeing. In fact the state currently pays hospitals based upon the volume of MaineCare patients that they cared for in 2002 ignoring significant increases in MaineCare patient utilization. More than 60,000 people have enrolled in MaineCare since 2002 with the program currently providing coverage to more than 265,000 Mainers. This means that each week hospitals are providing care to hundreds of MaineCare patients without receiving any payment from the state. This gap in hospital PIP payments between the state budgeted payments and reality is creating serious hardship on hospital cashflow. While historically it was understood that the PIP payments were estimates that would be dealt with at the end of the hospital’s fiscal year in a settlement process with the state, the current PIP payments are no where near based on current utilization. Leaving hospitals waiting for the state to make settlement payments, but this is of course the other part of the problem. Year-end Settlements At the end of a hospital’s fiscal year following the submission of a report to the state, there is supposed to be a timely process of “settling” with the state regarding the true number of MaineCare patients cared for by each hospital. While PIPs are supposed to be a realistic estimate of the number of patients a hospital will serve, no one expects those payments to cover all the services hospitals provide MaineCare patients. So, at the end of the fiscal year, the state is supposed to settle up with the hospitals and pay them for the patients not covered by the interim payments. But the state hasn’t paid the full amount it owes in years. Because of these state budget decisions that ignore the true costs of the growing enrollment in MaineCare, hospitals are now owed hundreds of millions of dollars by the state. Hospitals Borrowing Money to Meet Payroll? The combination of the gross under-funding of hospital prospective interim payments and the significant delays in hospital settlements has created serious cash flow problems for many Maine hospitals, forcing some hospitals to borrow from lines of credit to meet payroll. Compounding the problem is the fact that MaineCare, even when it pays for its patients, only reimburses hospitals 75 cents for every $1 dollar of the cost of care hospitals provide. The state also assesses a $55 million “sick tax” annually on hospitals as a means of leveraging more federal Medicaid dollars for Maine. A tax that leaves 31 hospitals paying in more tax than they receive back from the state in the form of a match. Such chronic underpayments limit hospitals’ abilities to meet the health care needs of their communities. Maine doesn’t have a statewide public health infrastructure; hospitals pick up the slack. Across the state, hospitals subsidize physician practices in underserved areas, dentist offices to ensure that MaineCare patients can get low cost dental care, home health agencies and nursing homes. Maine hospitals’ missions focus on improving the health status of the people in our state’s communities . . . providing free clinics, promoting health, implementing disease management protocols to improve the health of people www.anamaine.org FALL 2005 PAGE 19