THE OFFICIAL President’s Message Executive Director
OF THE MONTANA
Linda Henderson, MNA President
Working Toward a Legislative
Spring is in the air and summer will be
upon us soon. As we move into spring
cleaning and summer activities, I have a Eve Franklin, RN, Executive Director
couple of items for you to participate in,
one for self-improvement and the other to As we approach the 2007 legislative
VOL. 43 NO. 2 improve health care in general. session the MNA Board of Directors and
In a recent discussion with pre-nursing the Council on Practice and Government
APRIL-JUNE 2006 students, I discussed the fact that the Affairs moves into position to evaluate our
majority of nurses will deal with geriatrics stance in relation to the current political
in their practice whether they are specifi- and practice climate. The Board and the
cally working in adult care or not.As most Council being action oriented bodies,
of you know, this is due to the growing Linda Henderson
must evaluate what are seen as the major
number of elderly individuals in all of our communities in Mon- opportunities and obstacles that lie ahead
tana. Even if you work with pediatric patients you are likely to find as well as make recommendations to the
yourself dealing with grandparents as caregivers and legal House of Delegates as to the specifics of
guardians. As clinicians we all have the responsibility of keeping our legislative package. Eve Franklin
our knowledge and skills up to date. To improve your geriatric The Board of Directors highlighted a
knowledge, I encourage you to take advantage of the continuing number of issues as being key in the direction of nursing and
education offered locally through the Montana Geriatric Education health care in Montana in the year ahead. Over the next several
Center. issues of the Pulse we will be running issue oriented articles
The Montana Geriatric Education Center (MTGEC) is a consor- authored by your Board members that cover these pivotal issues.
tium effort of the University of Montana, Montana State University Some may appear as a result of concerns by the regulatory com-
and Rocky Mountain College and was funded through a grant from munity, some are issues that MNA may introduce, and some are
the Department of Health and Human Services, Health Resources issues with overarching importance that are of significance to con-
Services Administration, and Bureau of Health Professions. It is cur- sumers of health care.The issues that will be addressed are those
rently offering WebCT online courses for continuing education or of mandatory continuing education, the use of unlicensed person-
academic credit in multiple areas of geriatric care.You can review nel, the multi-state licensure compact, and issues affecting APRN
the available courses and register online by going to http://mtgec.
Awards montana.edu/. Fees are nominal and it’s a great way to improve
In 2007 we will be asking you to be extra vigilant in being aware
Nominations Due your understanding and knowledge base of geriatric care. Due to of important nursing issues that come before the legislature. You
budget cutbacks by the federal government ongoing existence of
July 31 this program is in jeopardy, so take advantage of it now.
will be asked to make phone and personal contacts with your local
legislators at critical times when legislation is being considered.
See details on page The other opportunity for participation comes in the form of Some of you will be asked to provide insight and advice about par-
16 & 17 improving our health care across the United States.All individuals ticular legislation based on your expertise and some will be tapped
residing in the US have the opportunity to participate in the Citi- to provide testimony before the legislature. It will take all of our
zens Health Care Working Group accessible online at http://www. skills and energy to make certain the outcome of the upcoming
citizenshealthcare.gov/. This group was authorized by Congress legislative session represents the best policy possible for con-
through the Medicare Prescription Drug, Improvement & Modern- sumers of health care; our patients in hospitals, nursing homes and
ization Act of 2003 and is charged with answering four vital ques- communities.
Annual E & GW tions:
1) What health benefits and services should be provided?
Retreat 2) How does the American public want health care delivered?
Page 3 3) How should health care coverage be financed?
4) What trade-offs are the American public willing to make in
either benefits or financing to ensure access to affordable,
high-quality health care coverage and services?
The Health Care Working Group is conducting community
forums across the country through April 2006, although none will
be held in Montana. Our opportunity to participate comes through
the website noted above. Once you have accessed the site, click on
“Tell us what you think” tab on the left and choose “Public com-
Student News ment center.”This will allow you to access reports on the current ANNUAL CONVENTION
Pages 8 & 9 status of health care in the US as well as to complete a health care
poll. I would urge you to read “The Health Report to the American
People” prior to completing the poll to be a better informed par-
OCTOBER 12-14, 2006
ticipant. Nurses have a lot of knowledge and experience to offer BILLINGS, MT
regarding the current health care system, what works and what
doesn’t. I urge you to take advantage of this opportunity for nurs-
es’ voices to be heard as a part of the health care team as well as
consumers of health care.
Once you’ve completed these activities, it’s time to take a break,
put your feet up and enjoy the sunshine. Have a good summer!
Page 2—Montana Nurses’ Association Pulse—April, May, June 2006
Labor Relations The Pulse
Official Publication of
the Montana Nurses’
Notice to Persons Covered by Union Security Agreements Association
Regulated Under the National Labor Relations Act CONTACTING MNA
Pat Wise, Labor Relations Director union security agreements who notify in writing MNA Montana Nurses’Association
Labor Relations Department, 104 Broadway, Ste. G-2, Hele- 104 Broadway, Suite G2
Montana Nurses’ Association, na,MT 59601 of their objection.Objections may be filed at Helena, MT 59601
Phone (406) 442-6710
like other unions, spends the any time but must be renewed each year.Objectors will be Fax (406) 442-1841
vast majority of its funds on col- charged only for expenditures related to representational Email: firstname.lastname@example.org
lective-bargaining related activi- activities. Website: www.mtnurses.org
Office Hours: 8:30 a.m.-4:30 p.m.
ty, as well as some amounts for All nonmembers who file such an objection will Monday through Friday
political lobbying, community receive MNA’s current Report of Expenditures Incurred in
services, organizing, charitable Providing Collective Bargaining Related Services. This WHO WE ARE
donations, publications advanc- Report provides the basis for the amount, which will be
ing the union’s political posi- charged to Objectors as a result of their objection. The The Montana Nurses’Association is a professional association for
tions,certain litigation,and other Report arrives at this amount by an analysis of MNA’s prior registered nurses, including advanced practice registered nurses,
students and retired nurses in Montana. MNA provides collective
matters. Under the Supreme fiscal year expenditures, which provides a detailed alloca- bargaining services, continuing education, and professional
Court decision in Communica- Pat Wise tion of those expenditures between expenditures which networking opportunities. MNA advocates on behalf of nurses
tion Workers of America (CWA) v. Beck, non-union mem- are related to MNA’s representational activities, and from before the Montana legislature, the Montana Board of Nursing,
and other public policy bodies.
bers who pay money to the Union under union security which the amount charged Objectors is derived, and
agreements may file objections to non-representational expenditures which are not or may not be so related.
related expenditures of the money they pay under such Any challenge by an Objector to the calculations in the MISSION STATEMENT
agreements. (Such agreements, including those that the Report or any challenge by an objector claiming the
MNA is a party to,may be and are applied by the MNA only Report does not properly determine what portion of The Montana Nurses’Association promotes professional
to require as a condition of employment that covered MNA’s expenditures were expended on matters unrelated nursing practice, standards and education; represents
employees be and remain persons who tender to the to representational matters,will be referred to an impartial professional nurses; and provides nursing leadership in
promoting high quality health care.
Union “the periodic dues and initiation fees uniformly decision maker appointed by the American Arbitration
required as a condition of acquiring or retaining member- Association under its Rules for Impartial Determination of MNA
ship” in the Union.The application of such clauses to non- Union Fees. Such challenges by Objectors to the Report
members who submit objections to the MNA under Beck must be made in writing, and must be addressed to MNA’s Board Executive Committee:
is handled in the manner described herein.) Labor Department, 104 Broadway, Ste. G-2, Helena, MT President Linda Henderson, RN
President-Elect Tina Hedin, RN
To comply with the Beck decision, the MNA honors 59601. Secretary/Treasurer Lori Chovanak, BSN, RNC
objections by nonmembers of the union covered by NLRA
Board of Directors:
The UAN and Clinical Nurse Leaders
Brenda Donaldson, RN Mary Claire McGuire, FNP
Maxine Ferguson, RN Barb Prescott, RNC, FNP, ND
Pauline Flotkoetter, RN Rebecca Schneider, APRN
Amy Hauschild, RN
At its March Convention,The National Labor Assembly an RN with a master’s degree prepared to oversee care
Editor: Eve Franklin
(NLA) of the United American Nurses (UAN) voted to coordination and evaluate care for a distinct group of Assistant Editor: Jolene Devine
oppose the further development of the position of Clinical patients and actively direct patient care in complex situa-
Nurse Leader (CNL), and to convey this resolution to the tions. This role of CNL was supposedly developed to Lynn Hebert RN, Chair—Sun River
AACN,the organization responsible for the development of address the nursing shortage by filling a gap in the current Mary Pappas,APRN—Havre
the CNL position and definition of its role in acute care set- health care arena by preparing yet another path of master’s Barbara Prescott,APRN—Lakeside
tings. prepared nursing leaders who can focus on the structure, Mae Rittal, RN—Sidney
Rachel Rockafellow, RN—Bozeman
There are multiple reasons for Montana Nurses’Associ- processes, and procedures of both the formal and informal
ation to support UANs opposition. systems of care as well as policy-level decision making in MNA Staff:
Eve Franklin, Executive Director
Currently, the RN at the point of care assumes the the organizational and national health policy arenas (Jour- Pat Wise, Labor Relations Director
responsibility and plan development, implementation, and nal of Professional Nursing, March-April, 2005). Raymond Berg, Labor Relations Specialist
evaluation of the client/patient plan of care. Not only are Rather than helping to fill the nursing gap, the role of Jan Kiely, Chief Operating Officer
nurses at the bedside expected to delegate and deliver CNL: Jolene Devine, Project Manager
Barb Swehla, Continuing Education Coordinator
highly complicated,individualized care to patients who are • moves responsibility and accountability for patient Marcy McLean, Grant Administrator
sicker, increasingly diverse and more informed, they are care away from the RN and the point of care; and
also responsible for unplanned system and environmental • directly conflicts with collective bargaining work Questions about your nursing license? Contact the Montana
factors in a condensed time frame (“Complexity Compres- thereby eliminating collective bargaining positions; Board of Nursing at: (406) 841-2300.
sion,” Minnesota Nursing Accent, 2005). and
As was reported in the UAN Report to the National • places a novice RN in a position of leadership over WRITER’S GUIDELINES:
Labor Cabinet in 2005,the Clinical Nurse Leader (CNL) is the expert nurse, thereby interfering with the novice Any author is welcome to submit an article related
to expert model of nursing care; and to nursing or Montana nurses in The Pulse. Please
• adds to the burden of the current critical shortage of contact the Assistant Editor at email@example.com.
nurse educators; and
• creates confusion for the patient population, adding PUBLISHER INFORMATION & AD RATES
yet another level of care providers.
In addition, lack of communication among the health Circulation 17,000 to every Registered Nurse,
care team is regularly cited as the number one cause of sen- Licensed Practical Nurse & Nursing Student in Mon-
tana. The Pulse is published 4 times annually by the
tinel events (JCAHO Resource Report, 2005) and the CNL Arthur L. Davis Agency for the Montana Nurses’Asso-
role creates an additional layer of nursing personnel that ciation, 104 Broadway, Suite G-2, Helena, MT 59601.
could complicate and confuse the authority for clinical
decision making and communication within the health Acceptance of advertising does not imply endorse-
ment or approval by the Montana Nurses’Association
(continued on page 3) of products advertised, the advertisers, or the claims
made. Rejection of an advertisement does not imply a
product offered for advertising is without merit, or
10”Granite County Memorial Hospital ad that the manufacturer lacks integrity, or that this asso-
ciation disapproves of the product or its use. MNA
RESERVED - Spot Page 2 and Arthur L. Davis Publishing Agency shall not be
held liable for any consequences resulting from pur-
chase or use of an advertiser’s product. Articles
appearing in this publication express the opinions of
the authors.They do not necessarily reflect views of
the staff, board or membership of MNA or those of
the national or local associations.
Advertising Rates: Contact Arthur L. Davis Agency,
517 Washington St., P.O. Box 216, Cedar Falls, IA
50613, 800-626-4081. MNA and the Arthur L. Davis
6”ALD Strange Codes ad Agency reserve the right to reject any advertisement.
Responsibility for errors in advertising is limited to
corrections in the next issue or refund of price of
Material is copyrighted 2005 by the Montana Nurses’
Association and may not be reprinted without writ-
ten permission from MNA.
April, May, June 2006—Montana Nurses’ Association Pulse—Page 3
Annual E&GW Retreat A Success! UAN and Clinical Nurse Leaders
(continued from page 2)
Pat Wise, Labor Relations Director care team. In contrast, a broad array of patient safety data
continues to bear out the importance for clinical decision
Over a three-day period, members of local bargaining making to be at the bedside where specific expertise about
units, E&GW leadership and MNA staff engaged in active the decision exists (IOM Report: Keeping Patients Safe,
dialogue with specialists in organizing, wage and hour 2004).
requirements, labor management relations and systems While the UAN recognizes that new curricula and
development to continue the process of building and changes in nursing are inevitable and certain, there is little
strengthening MNA throughout Montana. The agenda research-based evidence that the role of CNL improves
covered a broad range of issues. care for patients or enhances nursing practice. Further,
On the policy level, E&GW Chair Amy Hauschild pro- there currently are programs in place that serve post-bac-
vided the group with an overview of UAN activities calaureate students on a fast track to a certificate in nurs-
including the passage of the Mobilization Fund, which ing as well as BSN programs designed to meet the needs of
will raise membership dues by $30.00 annually starting these students elected nursing leaders in practice as well
January 1, 2007. This fund will be used to assist state Ever consider continuing education with a as academia should be shaping the future of nursing edu-
associations in organizing new nursing units. Montana is glorious view? Mark your calendar for April 2007 cation.
currently enjoying the assistance of a new National for fine food, extraordinary education and
Organizer from the UAN. Jason Hatch, formerly with the comradere. What the UAN does advocate is:
Oregon Nurses Association has been assisting the Training for this year’s Retreat focused on input pro- • a nursing care model that encourages professional
E&GW and MNA staff to assess organizing opportunities vided by members in a December MNA survey.The sur- growth of the RN at the bedside and in the work-
around the state. The implications of an NLRB ruling vey showed that local bargaining unit leaders and place while maintaining decision-making at the point
sometime early this fall on the 2001 Kentucky River case activists wanted additional training on the how to’s of of care; and
that classified charge RNs as supervisors were also developing local leaders and activists, as well as educa- • registered nurse leadership roles in its collective bar-
reviewed. tion on issues relevant to collective bargaining. gaining units for experienced,expert nurses who are
MEA/MFT Organizing Director Melissa Case provided uniquely qualified to work with patient populations
materials and guidance concerning the challenges, pit- and direct care at a systems level while keeping their
falls and techniques of designing and implementing an expertise at the bedside.UAN does not support entry
internal organizing campaign.Authorities from the state level nurses starting their career in management
Department of Labor shared their expertise on Wage roles.
and Hour laws and Montana’s Nursing Scope of Practice In conjunction with the UAN, the MNA will continue to
laws and regulations. In addition, participants received use collective bargaining and political action to support
insights into effective conflict resolution, a primer on the efforts of its members to enhance the expertise and
basic collective bargaining skills and an overview of the leadership abilities of experienced clinical registered nurs-
Family Medical Leave and Americans with Disabilities es and to demand to have a voice whenever changes in the
Acts. nursing care delivery system and the role of the bedside
Using the various tools and techniques developed nurse in providing quality care and maintaining safety of
during the Retreat, participants completed their train- the patient is being discussed.
Attendees take a moment to gather for a photo ing with a strategic planning session focused on grow-
during a break at the Chico Local Unit Retreat ing local unit agendas and projects for the next year.
April 24 & 25, 2006.
Attendees gleen FMLA and ADA information
provided by MNA Labor Director Pat Wise.
5” ads 10” Great Falls Clinic ad
OPEN RESERVED - Spot - Page 3
6”Valley View Home ad
RESERVED - Spot - Page 3
Page 4—Montana Nurses’ Association Pulse—April, May, June 2006
UAN Mobilization Fund RNs Part of a Greater Whole
Amy Hauschild CGRN Raymond Berg, Labor Relations Specialist whole we must have an awareness that is more expan-
sive than personal needs and even broader in vision
As many of you are aware, Nurses are socialized and than just unit needs.
our National Union is called acculturated to be part of Our own Associations’ mission statement asks a for a
the United American Nurses greater whole that focuses not similar blend of concrete action and altruism.
(UAN). Each year the UAN merely on self, but on the larg- The Montana Nurses’ Association promotes
holds the National Labor er community of colleagues professional nursing practice, standards and edu-
Assembly. This meeting is and health care consumers.We cation; represents professional nurses; and pro-
where elected delegates from need only to reflect on tradi- vides nursing leadership in promoting high qual-
each state gather to discuss tional roots to find the seeds of ity health care.
UAN business and operations, this world view. There are The verb choices of the MNA Mission Statement are:
discuss and vote on any resolu- many of you who remember promotes, represents and provides. The definitions of
tions which may come before having said the Nightingale the verbs meanings start a person on the correct think-
the house and to plan and Amy Hauschild pledge at some point during Raymond Berg ing of how to get to be a part of the whole.
shape the future of the organization. Montana has 3 your education. Many nursing programs today still have Promote: To contribute to the progress or
such elected delegates, this year all 3 are from the Mis- students recite the words. There may be parts of the growth of; further.
soula area. Maria Gurreri from Community Medical Cen- pledge that strike us as archaic in that some of the val- Represents: To substitute in some capacity for;
ter, Kate Steenberg and Amy Hauschild from St. Patrick ues are deeply rooted in the Victorian era . . . in particu- act the part of, in place of, or for (as
Hospital attended the delegate assembly in Miami dur- lar the phrase “aid to the physician;” the incorporation another person) usually by legal
ing the 3rd week of March. of a rather traditional notions of “purity.” Updated ver- right:
This year much of the work of the assembly centered sions of the pledge have omitted the “handmaiden” lan- Provides: To furnish; supply
on the concept of the “Mobilization Fund.” In 2005 the guage and substitute a more autonomous view of the The greater whole of nursing requires efforts in col-
state delegate representatives put forth a resolution relationship between nurse and patient. But looking lective bargaining, grievances and due process for nurs-
directing UAN leaders and staff to investigate starting a beyond the social notions of the Victorian era, and find es. The greater whole requires nurses to protect their
specific fund to assist states with organizing new RNs, the eternal values of nursing that consistently places profession and practice through legislation and admin-
to provide direct support to states experiencing collec- nursing as one of the most trusted professions in the istrative rules. Society has high quality healthcare when
tive bargaining emergencies such as strikes, or other country; loyalty to patients, strict confidentiality, com- nurses speak in unison to the issues impacting nursing.
unions trying to raid UAN local units etc.The Mobiliza- mitment to high professional standards, and conscien- Nursing, when true to our roots represents quality
tion Fund concept was widely adopted. A small group tious practice standards above all else: healthcare thereby contributing to the greater whole.
of state leaders assisted with crafting language and sev- Nursing is a major part of the healthcare business
eral conference calls were held with individual state The Florence Nightingale Pledge regardless of practice setting. The success of any busi-
nurse leaders, delegates and staff in order to receive I solemnly pledge myself before God and in the ness requires financial, physical and human resource to
input. Mobilization Fund monies will be used to hire 12 presence of this assembly, to pass my life in purity and compete in the market area and the legal standards of
National Organizers to assist states with individual pro- to practice my profession faithfully. I will abstain from the greater whole. As legal issues and financial reim-
jects. On a basic level, UAN dues will be increasing by whatever is deleterious and mischievous, and will not bursements become more of a burden to the business of
approximately $30 per year.This represents an increase take or knowingly administer any harmful drug. I healthcare, nurse-patient ratios increase and time for
of approximately $1.15 every two weeks. Specifically, will do all in my power to maintain and elevate the each patient goes down. Reread the mission statement
the increase will be placed in a segregated fund only to standard of my profession, and will hold in confi- and the oath again, and ask yourself,“Do I contribute to
be used for the above stated purposes.The Mobilization dence all personal matters committed to my keeping the greater whole?”
Fund Resolution was passed with resounding success. and all family affairs coming to my knowledge in the A nurse becomes a part of the greater whole of
The dues increase will be effective 1/1/07. On a more practice of my calling.With loyalty I will endeavor to healthcare when they vote, when they participate leg-
local Montana level, we have already seen benefits from aid the physician in his work, and devote myself to islatively, and when they work towards the improve-
increased UAN staff. We have received assistance from the welfare of those committed to my care. ment of wages, benefits and working conditions
the National Union on a couple of projects we are Re reading these words recited hopefully by so many through collective bargaining agreements. Nurses are a
working on in Montana. The Mobilization Fund is generations of nurses it is fair to ask oneself “Do I take part of the greater role when they educate and mentor.
money well spent. An investment in UAN is an invest- the necessary steps to elevate my profession?” If you do Nurses are a part of the greater whole when they
ment in Montana Staff Nurses. and the answer is yes, then rest assured you are a part of defend their colleagues and pursue due process. Nurses
the greater whole. But the next level of the question for are a part of the greater whole when they spend their
MNA bargaining unit members is “How does the time with the patients. Nurses become apart of the
Nightingale ethic translate into my collective bargaining greater whole when they contribute to the whole of
If you are a staff nurse involved in collective bargain- In conclusion, remember healthcare has always been,
ing be certain that you are negotiating for the greater in the context of it’s time, a business endeavor. Nursing
good and not outside of the contract to fulfill a person- is an integral part of that business. It is a privilege to
al desire—or satisfy the desire of only your unit. If we work with nurses that see the big picture of healthcare
are not ever-conscious of the “big picture” and how our and the importance of nursing in the healthcare busi-
individual actions affect the state of health care in gen- ness and work with them to promote professional nurs-
eral, patients, and other nurses in different settings, then ing practice, standards and education; represent profes-
according to Florence Nightingale such efforts are “dele- sional nurses; and provide nursing leadership in
terious and mischievous.” To be a part of the greater promoting high quality health care. Businesses’ need
12” ads financial, physical and human resource. As a nurse are
OPEN you contributing to the progress and growth of nursing?
Do you supply resource? Do you contribute to the
greater whole of nursing practice and healthcare?
April, May, June 2006—Montana Nurses’ Association Pulse—Page 5
Call for Articles The Editorial Board Wants You
Lynn Hebert, RN, Editorial Board Chair Lynn Hebert, RN, Editorial Board Chair
The due date for articles for the July,August, Septem- Have you ever wondered how you can get involved in your professional organization? The Editorial Board is a
ber issue of the Pulse is July 1, 2006. The issue of the great way to get started.The Editorial Board solicits and reviews content for the Pulse, your official publication of
Pulse will be mailed the third week in August. the Montana Nurses’ Association. Note that the board solicits articles.You don’t have to write articles, just get out
We welcome your articles for the Pulse. If possible, there and get nurses to submit articles about the interesting things they are doing.
please send them by e-mail, either as an attachment or The Editorial Board meets quarterly the first weeks of January,April, July and October.The January,April, and July
as text to Jolene Devine, meetings are by conference call and the October meeting is a face-to-face meeting at convention.The bulk of the
Assistant Editor, or Lynn “Articles indexed in work is done by e-mail with articles sent to all committee members for review.
Hebert, Editorial Board CINAHL . . . ” We welcome your participation. If you are interested in a fun and educational committee of your professional
Chair. The e-mail organization, please contact any of the following members:
addresses are firstname.lastname@example.org and artlynn@
3rivers.net. Emailing is the preferred way for article sub- Eve Franklin, MNA Executive Director, Editor email@example.com
missions but you may certainly mail in articles also to: Jolene Devine,Assistant Editor firstname.lastname@example.org
Montana Nurses’ Association, 104 Broadway, Suite G-2, Editorial Board Members:
Helena, Montana 59601. Lynn Hebert, Chair email@example.com
If writing intimidates you, or even if it doesn’t, you Barb Prescott firstname.lastname@example.org
can call the MNA Office for assistance.We want to share Mary Pappas email@example.com
your information with other nurses in Montana. Pulse Rachel Rockafellow firstname.lastname@example.org
articles are reviewed by a committee of your peers and Mae Rittal email@example.com
indexed in the Cumulative Index to Nursing and Allied
Health Literature (CINAHL).
We also welcome your pictures. Remember the old
saying:“A picture is worth a thousand words.”You’re not
completely off the hook
“Pictures, we love though. When you do
pictures . . . ” send pictures, please
send the name of the
people who are in the picture and a caption for the pic-
ture. If you want the photo returned, please indicate
that and include your return address.
6” ads 6” ads
22.5”Travel Nursing.com ad 22.5” SW Healthcare Services ad
RESERVED - Far Forward - RH page RESERVED - Page 5
Page 6—Montana Nurses’ Association Pulse—April, May, June 2006
Are We Ready For Mandatory Continuing Education? B. a national certifying body
Mae Rittal, Sidney, and Maxine Ferguson, Helena, another state for the • Emergency Medical Tech-
members MNA Board of Directors provider functions. nicians
• MNA now contracts with • Nutritionists/Registered
Actions in the 2004 and 2005 MNA House of Dele- the Ohio Nurses’Associa- Dietitians
gates support moving forward with a continuing edu- tion for the provider • Medical Doctors and
cation requirement for Montana nurses. This article functions. Clearly, contin- Osteopaths
explores the issue and solicits your input. uing education is a long- • Registered Nurses who
1. Is a mandatory continuing education require- standing priority of are certified by a national
ment needed in Montana? MNA. certifying body, such as
Many nurses already attend continuing education • The structure of the ANCC. Other registered Maxine Ferguson
(CE) classes at their place of work, at MNA convention, Association includes a nurses have no continuing education require-
at other conferences and workshops. Because many of Council on Continuing Mae Rittal ments.
Montana’s nurses are certified in their practice area by Education (along with Councils on Economic and
a national certifying body, such as American Nurses Cre- General Welfare, Practice and Government Affairs, 4. What is required for nurses in other states?
dentialing Center (ANCC), they already are taking con- and Advanced Practice).As with each of the other • Of the 52 states and constituencies, 25 require
tinuing education courses. Some could argue that nurs- councils, there is a Board of Directors representa- continuing education for licensure renewal for
es are already participating in continuing education. tive for continuing education. RNs.
Others say that a mandatory requirement for CE is nec- • Through a grant from the U.S. Department of • The average requirement is about 24 contact
essary to ensure that nurses who might not otherwise Labor, MNA is preparing online continuing educa- hours every two years.
participate in CE are required to. Many other profes- tion related to workplace violence. • Nearly half of the states have approval mecha-
sions require continuing education for licensure or cer- • At this fall’s MNA convention in Billings, over 30 nisms in place (ANCC or other) to approve and/or
tification. Professional nursing is one of the few profes- workshops and plenary sessions will be offered provide continuing education for RNs, which
sions that does not require continuing education for on a variety of topics. All will award continuing seems to demonstrate that CE is a priority for
relicensure or certification. education contact hours. those states.
• MNA has recruited a registered nurse whose pri-
2. What is MNA’s position? mary responsibility is continuing education. 5. Where does my employer stand in regard to
MNA believes that the primary responsibility for edu- • MNA’s labor department actively supports contin- continuing education?
cation rests with the individual nurse, but that mecha- uing education through language in collective bar- Many hospitals, some smaller rural facilities, provide
nisms need to be in place to support this belief. The gaining agreements with major employers of nurs- funds for nurses to continue their education. Hospitals
Board of Directors has agreed that we need to look seri- es throughout Montana. may pay registration fees, expenses, and permit atten-
ously at implementing a requirement for mandatory dance at continuing education without loss of pay.
continuing education in Montana. Actions of the 2004 3. What is currently required for Montana nurses Some continuing education may be mandatory, such as
and 2005 MNA House of Delegates have supported and others? ACLS, and in some facilities CE hours in addition to
moving forward with a mandatory education require- The only statutory (Montana law or rule) require- mandatory hours are paid, generally with a limit on the
ment. It will take a lot of work to put a requirement in ment for continuing education for nurses in Montana number of CE hours per year.
place for a certain number of continuing education affects advanced practice registered nurses (APRN), Hospitals and other agencies approved by the Mon-
credits or contact hours to renew one’s license. who are required to have 20 hours of CE annually; 25 tana Nurses’ Association to be providers of continuing
MNA currently has several approaches in place that hours annually if they hold prescriptive privileges. education (Approved Providers) offer many hours of
support continuing education: Many other Montana health providers and profes- continuing education that award contact hours. These
• MNA is accredited by the ANA Council on Accred- sionals with whom nurses might work are required to approved providers include
itation as an approver of continuing education for have continuing education ranging from less than 10 • Benefis Health Care, Great Falls
nurses in Montana. In 1981, the Montana Nurses’ hours per year to over 30 hours per year, either through • Bozeman Deaconess Hospital, Bozeman
Association was approved by the American Nurs- A. a statutory • Billings Clinic, Billings
a statutory requirement is
es’ Association Credentialing Center (now ANCC) requirement. • Kalispell Regional Hospital, Kalispell
in place for:
to approve and provide continuing education for - Direct entry • Missoula Community Medical Center, Missoula
nurses. The approver function continues to be midwife • St. Patrick Hospital & Health Science Center,
accredited. A decision was made to go through - Naturopathic Missoula
- Respiratory Care
physician • St. Peter’s Hospital, Helena
- Chiropractor • St.Vincent Hospital, Billings, and the
- Clinical Lab • Montana Geriatric Education Center, Missoula
- Clinical Profes--
Scientist/Specialist MNA represents nurses in most major hospitals as
- Dentist well as other healthcare facilities across the state. Lan-
- Clinical Social
- Occupational guage in collective bargaining agreements that support
Therapist continuing education generally is similar to the follow-
- Audiologist / Audi--
- Physical Therapist ing, with specifics added for each institution:
- Clinical 1) Compensation for mandatory in-service is at the
Psychologist nurse’s regular rate of pay unless the Hospital
requires attendance at a time that results in over-
(continued on page 5)
April, May, June 2006—Montana Nurses’ Association Pulse—Page 7
Are We Ready for Mandatory
Continuing Education? CE CALENDAR
(continued from page 4) Reference Date Workshop Location Contact
2) Nurses may be required to provide an in-service to
their colleagues on what they had learned after 2005-37 10/1/2005- Clinical Application of Ventilator Waveforms Online 1 C.H.
9/30/2007 Contact: Loralee Goehle http://
completing a course. 925-788-9519 elearning.
3) Employees required by the hospital to attend edu- respironics.
cational seminars or meetings shall be reim- com
2005-38 10/1/2005- NPPV: Across the Continuum of Care Online 1 C.H.
4) Educational leave required by the Hospital shall 9/30/2007 Contact: Loralee Goehle http://
be without loss of pay to the employee. 925-788-9519 elearning.
5) In-service education programs will be provided respironics.
on a continuing basis for all nursing personnel. It com
is the responsibility of all nursing employees to 2005-39 10/1/2005- Respiratory Monitoring: Principles & Online 1 C.H.
attend mandatory in-service programs. 9/30/2007 Clinical Application of VCO2 http://
6) Upon completion of the probationary period, Contact: Loralee Goehle elearning.
each registered nurse shall be eligible for a mini- 925-788-9519 respironics.
mum number of hours [varies as much as 5 to 20] com
of education per year with pay.
7) Education shall include mandatory in-service, non- 2006-12 07/13-15/2006 Mountain States Genetics Regional Pending
mandatory in-service, and seminars authorized by Collaborative Center 2006 Annual
the Nursing Director. Contact: Joyce Hooker
8) Leave to attend professional education meetings 303-978-0125
may be granted without loss of pay.
9) Expense allowances may also be granted at the
discretion of the manager.
Amy Hauschild Honored by Barb Swehla Joins MNA Staff
6. Why is continuing education important? What
are the arguments for and against requiring
Nursing Colleagues MNA is proud to announce
the addition of Barb Swehla,
Amy Hauschild BSN RN, who MN, RN to our staff in the role
Many people, including some nurses, assume that
serves as a Board Member of of Continuing Education Coor-
once a nurse has finished her education and become
the Montana Nurses’ Associa- dinator. Barb will be further
registered, then that’s it, she/he doesn’t have to bother
tion and in the Economic and developing, refining, and imple-
with any more learning, he/she just gets on with look-
General Welfare Director posi- menting the continuing educa-
ing after patients. Nothing could be further from the
tion, was honored by her col- tion program at MNA. “The
truth.The table below highlights only a few of the argu-
leagues at St. Patrick Hospital in world of continuing education
ments on each side.
Missoula on Monday, May 8th has become very sophisticat-
2006 to coincide with their cel- ed,” stated Eve Franklin, Execu-
ebration of Nurses Week. She tive Director, “The Association Barb Swehla
• Continuing education can assist in retaining and
received the Nurse of the Year needs someone with Barb’s
recruiting nurses in a health care facility.A num- Amy Hauschild
Award, selected by her col- skills and expertise to help us grow our program in a
ber of studies have identified staff development
leagues for her excellence in service and practice. The way that is consistent with national best practices.” Barb
as a significant factor in nurse job satisfaction
membership of MNA would like to offer their congratu- completed her master’s degree in Nursing at Montana
lations and add our voice to the accolades, acknowledg- State University—Bozeman, served as Executive Direc-
• Many educational opportunities are available
ing Ms. Hauschild as a remarkable member of the nurs- tor of the Montana Board of Nursing and has been an
through professional publications and on the
ing community and constructive force for good within active clinician, nurse educator, and administrator.
Internet at very reasonable prices and can be
used at home when time is available.
• In one study, 47 percent of respondents had
some concern that their basic education did not
prepare them well.
• Montana is largely rural and this causes RNs to
travel great distances for educational opportuni-
ties and require greater amounts of time away
from home and workplace.
• Rural areas experiencing nursing shortages
which make it difficult to get time off from work
to attend educational offerings.
• Small hospitals aren’t financially able to offer 7” ads
• RNs working full time and raising families don’t 12” ads OPEN
have time to go to educational opportunities.
• Some nurses feel CE doesn’t make any difference OPEN
in patient care.
We’d like to hear from you! One of the arguments
against mandatory continuing education is that there
are not studies to show that continuing education
makes a difference in patient outcomes. What is your
experience? Write us with any thoughts you have about
how CE helped improve a patient’s outcome or helped
you be a better nurse.
Also, let us know of your problems in obtaining rele-
vant CE, your concerns about mandatory CE, or other
thoughts about continuing education in general.
Write to CONTINUING EDUCATION, MNA, 104 5” Saints Nursing Service ad
Broadway, Suite G2, Helena, MT 59601 or email Maxine
Ferguson at firstname.lastname@example.org or Mae Rittal at mrittal@ RESERVED - Page 7 - LRHC
Page 8—Montana Nurses’ Association Pulse—April, May, June 2006
Education Under the Big Sky
MSU College of Nursing Graduates First Upper Division
Class from Bozeman Campus
Rachel Rockafellow, MSN, RN, CWOCN Reflecting on generations of student nurses moving
from the student role to that of colleague and even our
May is an exciting time of year in Bozeman.The days care providers, the MSU College of Nursing has been
are getting longer, the weather a bit warmer, and many part of this annual procession since 1937 when Anna
young folks are about to launch into their first profes- Pearl Sherrick affiliated the hospital-based training pro-
sional jobs in their chosen careers, including becoming grams of Great Falls, Havre, and Bozeman with Montana
registered nurses. State College. The 1937 program began that fall with
As an adjunct assistant professor at the MSU College 194 students entering the program. Over the years
of Nursing, it is an honor to play a small part in the edu- upper division campuses have changed. (Butte was an
cation of the future leaders of the nursing profession. upper division site on two different occasions in our
One of the classes I teach is a lab (practice) section of history.) In the fall of 2005, we had 827 nursing stu- (Front row left to right): Brandom Jones, Rachel
“Health Assessment across the Lifespan.”The final expe- dents in our program. There are currently five upper Schweitzer, Chelsea Kostrba, Mayra Morgado,
rience has the students perform a physical exam on division campuses with 40 students graduating from Sarah Bogan, Tracy Cashman,Tracy Edwards, Kate
someone who has not taken the class. We often meet Billings, 16 from Bozeman, 15 from Great Falls, and 22 Keenan (back row left to right): Jon Balgeman,
boyfriends, girlfriends, and family members of our stu- from Missoula plus the 99 students who graduated in Ian McInroy, Kahrin Phillips, Libby Archibald,
dents at this time as they help students achieve their Fall 2005, including 6 from Kalispell. We usually gradu- Amber Overcast, Jessica Barnes, Jessyca Small,
goals. Last year one young woman brought her father, ate about 184 nurses a year. These students will gradu- and Sarah Atwood.
who had been the “patient” for her mother when she ate with their Bachelor of Science in Nursing degree or
went through our program years ago. It was a pleasure “BSN,” which makes them eligible to take the NCLEX Jon Balgeman, a graduate of Manhattan High School,
to see the love of nursing pass through the generations exam to become a registered nurse.They graduate at a was inspired to become a nurse after providing com-
and reminisce with her dad about his wife’s and his col- time of a great nursing shortage in our state and coun- munity health education in New Guinea. He is off to a
lege years at MSU. try and tremendous opportunities.As the only program specialized training program at Mayo in Rochester, MN,
About four years ago I had the pleasure of having offering graduate nursing education in the state, 11 new along with fellow graduate Sarah Atwood. Ian McInroy
Kayla McAvoy in the clinical portion of the “Fundamen- master’s prepared nurses (8 family nurse practitioners worked at a group home in Dillon and as a fly-fishing
tals of Nursing” class, where students meet their very (FNP), 2 clinical nurse specialists, and one post-master’s guide in Ennis before becoming a nurse. He will be tak-
first client as a nursing student in the local nursing FNP certificate) will also graduate from the MSU Col- ing critical care classes in Billings before starting work
homes and assisted living facilities. Kayla has since grad- lege of Nursing. in the intensive care unit at Bozeman Deaconess Hospi-
uated, worked for Bozeman Deaconess Hospital in their The latest Summary of the 2004 Graduate survey tal. Kahrin Phillips having worked at Bozeman Dea-
Medical-Surgical department for 2 years, and is now my shows that graduates of our program top the entry-level coness Hospital throughout her nursing classes is
husband’s nurse at Dr. Shaneyfelt’s office. salary of graduates of MSU for the first time ever at expecting her first child this summer with hopes of
Many years ago when I took the class Kayla was in, it $42,023 (even beating engineering at $41,975). All starting work in the operating room at Bozeman Dea-
was the last semester Milly Gutkowski was teaching at Montanans benefit from our program when 71 percent coness after her maternity break. Libby Archibald is off
the College of Nursing, and Milly was my instructor. of our graduates take jobs in Montana. Others may be to become a nun and provide health care for under-
Since graduating I have worked with Milly on behalf of like me, who go out of state for a number of years and served populations around the world. Brandom Jones
the Montana Nurses’Association to protect and advance return to where their hearts and families are after gain- will be getting married this summer before pursuing
the interests of nurses in Montana and consider her a ing valuable experience, education, and opportunities her dream job. Jessica Barnes is expecting a baby in July.
friend.This fall I will be the lecturer/instructor for that out of state. She plans to stay in Bozeman and will be applying to
course. While the College of Nursing originated and contin- Bozeman Deaconess Hospital after her maternity break.
ues to be administrated from Bozeman, we have never Jessyca Small is not sure where her path will lead her
had an upper division campus at this location until two yet, but she is proud to be following in the footsteps of
years ago.A “site analysis” had to demonstrate adequate her great-grandmother, who is the first registered Native
clinical facilities to provide the variety of educational American nurse, Susie Walking Bear Yellowtail. Tracy
experiences our students are expected to master. Many Edwards and Rachel Schweitzer are heading to Port-
financial hurdles were overcome to provide for addi- land:Tracy to work in pediatrics before applying to grad
tional educators for these students. The growth and school to be a pediatric nurse practitioner and Rachel
assistance of our medical community and hard work of to work in acute adult care and trauma.
our administrators has enabled this long-held dream to We are very proud of these and all the College of
become a reality.This month marks the first graduating Nursing students as well as their hard work and accom-
class from a Bozeman upper division campus. These plishments. Please join us in welcoming them into the
graduates include: nursing profession and wish them well. May you see
them socially and not need their services professionally!
6”ALD Strange Codes ad
April, May, June 2006—Montana Nurses’ Association Pulse—Page 9
Great Falls MSNA Helps Montana State University College of Nursing Celebrates
One of Their Own, Ed Dea 10 years of Family Nurse Practitioner Graduates
Sheri M. Byrnes, MSN, RN Deanna Babb, APRN, FNP
Eager “garage salers” were waiting at 8:00 am Satur- In 1994, the first students were admitted to the fam-
day March 25th to rummage through all of the donated ily nurse practitioner (FNP) option in the master’s
goods. Great Falls Area Montana Student Nurses Associ- degree program at Montana State University—Bozeman
ation (MSNA) organized a garage sale and worked hard College of Nursing. The first graduates of the FNP
to make it happen. Donated items for the sale came option finished the program in the summer of 1996.
from students, faculty, staff, friends, and friends of Montana State University College of Nursing was one of
friends. the first programs to offer graduate education via dis-
The sale did not officially start until 9:00 am but that tance delivery, requiring that students attend weekly
was no problem, especially because all the proceeds are courses via teleconference or interactive video at their
benefiting Ed Dea. He is a Montana nurse for over 16 local campuses: Billings, Bozeman, Great Falls, and Mis-
years and was diagnosed with promyleocytic leukemia soula. Initially, travel was required monthly to Bozeman
November 2005. Ed Dea is well known in Great Falls for face to face meetings. Students could continue to
work in their local communities while attending gradu- Current Students from left: Johnny Willcut, Wade
and known as a kind, tender, gentle soul. He has worked King, Ed Dea, David Vaughan
as an ER/Flight Nurse for Benefis Healthcare and con- ate courses.
tinues to work there part-time. He is presently with Since that time, graduates have gone on to fill prima-
MSU-Bozeman, Great Falls Campus, as an Adjunct ry health care needs locally, in rural and urban Montana,
Instructor. and abroad in places as far away as American Samoa.
Great Falls MSNA raised $1001.00 from the garage The graduates of the program, to date, have a 100% first
sale and donations. time pass rate on national family nurse practitioner cer-
tification examinations. Graduates of the program are
teaching nursing, operating their own primary care clin-
ics, caring for underserved populations, working with
specialty physicians, providing care in critical access
hospitals, working in emergency room fast tracks and
urgent care facilities as well as pursuing doctorate nurs-
ing education. 21”ads
The family nurse practitioner option is continuing to
grow and change at Montana State University.This past OPEN
year, the program became more accessible and flexible
using an “intensive” format for monthly course meetings
(From Left to right): Sheila Matye, Alan Wyland, times along with internet based course shells. Students
Kara Bakke, Heather Tackling, Lis Lincoln travel to Bozeman once in the fall for an intensive week,
which involves orientation to the program, meeting
classmates and faculty, and “front-loading” theory course
Zeta Upsilon—Creating content. Students travel to their nearby local campuses
Global Partnerships just 2 times per semester for Polycom interactive video
course meetings. Students connect 2 additional times in
the semester per teleconference from their local com-
Zeta Upsilon-At-Large Chapter of Sigma Theta Tau met munities.
in Bozeman on March 31st to participate in an excellent On May 5th, 2006, eleven students graduated from
program entitled “Creating Global Partnerships.” Dr. the family nurse practitioner program. Congratulations
Thomas I. Hayes Jr. spoke about the health care issues to all of the current graduate students and alumni of the
throughout the world and how these do and could in family nurse practitioner program at Montana State Uni-
the future impact the health of peoples in The United versity—Bozeman.
States. He has thirty years of experience in international
healthcare in Africa, The Middle-East, Asia, Europe and
America. Nurses need to be informed about these infec-
tious diseases now more than ever. Dr. Cynthia
Gustafson spoke about a project that she has been
involved with in Swaziland, Africa title “A New Robe.
This project was to help establish Parish Nurses in
Swaziland who could help those suffering from the
AIDS/HIV epidemic there. Dr. Gustafson shared some
personal stories of those suffering from this disease and
the different roles of the Parish Nurses. Can you imagine
walking 5-6 miles on a dirt path to visit a patient?
In the afternoon forty four new undergraduate stu-
dents from both Montana State University-Bozeman and
Carroll College and 2 community leaders were inducted
into Zeta Upsilon-At-Large Chapter and new officers
were installed.The new members are: Jennifer Anderson-
Malingo, Sarah Atwood, Kara Bakke, Jon Balgeman, Tara Students from left: Maureen Richter, Lianna
Beans, Jordan Bell,Amy Braaksma, Morgan Brown, Elisha Danielson, Kim Ackerman, Jennifer O’Neill
Cassan, Kiley Covey, Hanne Cundy, Jessica Freemole,
Maria Fullerton, Heidi Gildroy, Kaylee Harris, Jessica
Hawkins, Christy Hellekson, Colleen Iverson,Ann Jones,
Brittany Keller, Teela Kirn, Kelsey Kossler, Tiffany
Krueger, Heather Lambott, Jennifer Lessard, Nicholas
Marosek, Blair Mease, Paulla Mizer, Christine Morman,
Jayme Morrisette, Megan Paschke, Shelley Patterson,
Teresa Ritter, Rachel Schweitzer, Rachael Simons, Cor-
nelia Taylor-McKee, Jody Vines, Rebecca Walling, Hayley
Wright, Rebecca Zatorowski, Jessica Barnes, Garett 6” ads
Boese, Kacia Hansen, Dianna Joyce, Traci Lappin, Sarah OPEN
New Officers inducted were: President-Elect: Nadine
Parker, Vice-President-MSU: Linda Young, Secretary:
Joyce Hendricks; Carroll College Counselor: Heather
Onstad, MSU Bozeman: Billings Campus Counselor:
Betty Mullette; Great Falls Campus Counselor: Susan
Raph and Leadership Succession Committee: Jacque
Dolberry and Carolyn Wenger.
Page 10—Montana Nurses’ Association Pulse—April, May, June 2006
Advanced Practice Nursing
National Council of State Boards of Nursing Presents Draft • Boards of nursing define scope of nursing practice
(NCSBN)—ANA believes actual practice should be
Document “Vision Paper: The Future of Regulation of Advanced defined by the profession and the professional prac-
titioners not the regulatory entities.
Practice Nursing”—ANA Responds • The profession supports the need for second licen-
sure (NCSBN)—ANA disagrees with the assumption
Eve Franklin, MSN, RN 1. Boards of Nursing will be the sole regulators of
that the profession supports the need for second
licensure for an APRN.
The APRN Advisory Panel Of 2. APRN licensure will be in the categories and titles of
• The Clinical Nurse Specialist(CNS) no longer has a
the National Council of State nurse anesthetist, nurse midwife, and nurse practi-
relevant role in advanced practice nursing—ANA
Boards of Nursing (NCSBN) has tioner.
believes the skill set of the CNS provides critical
completed a document they 3. Boards of Nursing will approve APRN Programs for
advanced practice interventions in order to provide
have dubbed “APRN Vision purposes of licensure.
quality health care.
Paper” which is the product of 4. All programs leading to APRN licensure as a nurse
• All states will adopt the RN multi state compact and
approximately three years of practitioner including clinical practice doctorate and
the compact concept will be applicable to APRN’s
work. The stated purpose is to post master’s degree requirement will meet estab-
(NCSB)—ANA states only 21 states thus far have leg-
“bring uniformity, simplicity and lished educational requirements.
islated (though not necessarily fully implemented)
clarity to the regulation of 5. Requirements for licensure as a nurse practitioner
multi state compacts.ANA House of Delegates is on
APRNs.” At their February meet- will include successful completion of a core nurse
Eve Franklin record opposing multi state licensure and would
ing, the Board of Directors practitioner licensure examination and a residency
extend the same concerns, i.e. reconciling differ-
approved a dissemination plan to obtain feedback on the program.
ences between state practice with an APRN multi
draft paper. The feedback period will have closed by the 6. Evidence of continued competency will be required
time of the printing of this article (March 30, 2005) It is for purposes of licensure renewal.
• The broadest level of education for an advanced
important for the APRN community to know that the direc- 7. Fully licensed APRNs will be independent practition-
practice role is what is required for public safety,
tion taken by the NCSBN as outlined in the APRN docu- ers. After licensure there will be no regulatory
consumer knowledge and uniformity of regulation
ment has implications not only for regulation but also for requirements for supervision.
(NCSBN)—ANA does not support a generalist model
practice, education, certification and accreditation bodies. 8. The Advanced Practice Compact will be the regula-
for the APRN.The knowledge base for lifecycle con-
The purpose of this document as outlined by Nancy tory model used to effect mutual recognition of
tinuum of care is established at the RN level.ANA fur-
Chornick, PhD, RN, CAE, Director of Practice and Creden- advanced practice nurses.
ther maintains that consumer populations are well
tialing for NCSB,is to address what NCSBN sees as issues of There is certainly not unanimity in the nursing commu-
served by APRN specialty care—for example it can
“regulatory sufficiency” of advanced practice nursing.The nity on this perspective. While there are some points of
be demonstrated that pediatric nurse practitioners
Executive Summary states the NCSBN view that there is a agreement, the American Nurses’ Association as well as
are in a position to share more expert specialized
lack of uniformity nationally in the regulation, standards, other professional and credentialing bodies have offered
knowledge in pediatric needs than the average gen-
certification and legal authorization for APRNs practice; a responses that take issue with both some assumptions and
eral practice physician concluding that it makes it
lack of agreement on the role of the clinical nurse special- directions made explicit in the “Vision Paper.”
possible for consumers have increased access to
ist.The “Vision Paper” represents the NCSBN’s perspective In the document entitled American Nurses’Association
on the direction that boards of nursing and “APRN stake- (ANA) Comments Regarding the 2006 NCSBN Draft Vision
I urge you all to read these draft papers in their full form.
holders”should take over the next decade in the regulation Paper (read in it’s entirety on www.nursingworld.org) sev-
They are both compelling and provocative to those of us
of advanced practice nursing.The “APRN Vision Paper” can eral overarching comments are made. ANA states that
engaged in issues surrounding advanced practice.ANA has
be read in it’s entirety on the NCSBN website http://www. “while it respects the right of NCSBN to identify it’s con-
very specific responses to each of the 8 points made in the
ncsbn.org/. cept of future regulation of the nursing profession” they
NCSBN paper.The effects on the future of nursing practice
The following recommendations are made in the draft believe there are a number of “incorrect assumptions”that
and more importantly the health care model in which we
paper: underly the approach.
practice and receive care are critical.
April, May, June 2006—Montana Nurses’ Association Pulse—Page 11
Advanced Practice Nursing
Advanced Practice Nurses (APRN): Questions and Answers US Dept. of Transportation
Barb Prescott DNP, FNP, RNC Clinical Registered Nurse Specialists practice inde- Seeks Advanced Practice
pendently or work in hospitals, long-term care facilities, Nurses for Survey
History: The role of the advanced practice registered and other care agencies. They function as administra-
nurse originated with the need for increased access to tors, researchers, policy makers, educators, and consul- As part of the preliminary research being conducted
primary care in response to physician shortages in tants. for development of the National Registry of Certified
underserved areas. Federal legislation in the 1960s pro- Certified Nurse Anesthetists provide anesthetics in Medical Examiners (NRCME) program, the Federal
vided funding to develop nurses as primary care collaboration with physicians and other qualified health Motor Carrier Safety Administration (FMCSA) is in the
providers. By the 1970s, more than 500 programs were care professionals. CRNAs practice in every setting in process of identifying 5,000 medical examiners who
established to prepare nurses for primary care. By 1974, which anesthesia is delivered.When anesthesia is admin- currently perform physical examinations for commercial
the American Nurses Association published educational istered by a nurse anesthetist, it is recognized as the motor vehicle (CMV) drivers to complete a survey that
guidelines for preparing nurse practitioners and began practice of nursing. will help define the role of the medical examiner. This
the credentialing process. Certified Nurse Midwives provide primary health includes 1,000 from each of the following professions:
How many nurses practice in advanced prac- care to women. This includes evaluation, assessment, Advanced Practice Nurses, Doctors of Chiropractic, Doc-
tice nursing in the United States? According to the treatment, and referral to a specialist as needed. They tors of Osteopathy, Medical Doctors, and Physician Assis-
ANA Nursing World, there are 141,209 nurse practition- provide preconception counseling; care during preg- tants. If you currently perform these examinations,
ers (NPs), 72,521 Clinical Nurses Specialists (CNS), nancy and birth, normal gynecological services, and care please volunteer to take part in this important survey by
32,532 Certified Registered Nurse Anesthetists of pre- and post-menopausal women. providing the information requested on the web page.
(CRNAs), and 32,523 Certified Nurse Midwives (CNMs) What are the Montana requirements for becom- Please encourage your colleagues who perform CMV
in the United States. ing an advanced practice registered nurse? driver physical examinations to participate, as well.The
What do advanced practice registered nurses In order to become licensed as an advanced practice target deadline for identifying the 5,000 participants is
do? registered nurse in Montana, the APRN must be a regis- June 15, 2006.
Nurse Practitioners practice independently in acute tered nurse with an unencumbered license, must have For more information and to apply go to: www.
care settings.They function as clinicians diagnosing and earned a Master’s Degree in their area of specialty, and nrcme.fmcsa.dot.gov/.
treating a wide variety of acute and chronic illnesses become board certified by passing a National Certifica-
and injuries.They interpret lab results, counsel patients tion Examination. For continued licensure, the nurse
and develop plans for treatment, and prescribe medica- must maintain certification through mandatory continu-
tion. ing education according to the certification agency.
3” ads 3” ads
22.5”ALD Web Site ad 22.5” ads
RESERVED - 4 color OPEN
Page 12—Montana Nurses’ Association Pulse—April, May, June 2006
Multi-State Nurse Licensure Compact–What and Why Nurses Have Hearts for
History: The National Council of State Boards of How are violations of the Nurse Practice Act Children
Nursing (NCSBN) began deliberation regarding the cre- reported and processed? They are processed in the
ation of a nurse licensure compact in 1996. In 1997 the state of violation and the action taken would be report- Susan Barros, PATH Family Developer
delegates to the NCSBN voted unanimously to endorse ed to the state of residency. If a violation occurs in the
a mutual recognition model for nursing regulation. In state of residency, all states in the compact are notified Did you know there were more than 1000 reports of
l998 the delegates approved a policy to remove regula- of the violation and the action taken. The NCSBN has child abuse and neglect, and over 3000 Montana chil-
tory barriers to increase access to safe nursing care. established a licensure information system called dren were living in out of home care in 2004?
And in 2000, the first participating states joined a com- Nursys to enable the sharing of information.This infor- Because of their special needs, many abused and
pact: Maryland,Texas, Utah, and Wisconsin. mation is available to all state’s Boards of Nursing. neglected children require therapeutic support and a
What is a mutual recognition model? This model Does compacting affect collective bargaining percentage of these are in severe emotional distress.
allows a nurse to have a license in the state of primary rights? Compacting does not impact the statutory Birth, relative, foster, and adoptive parents often struggle
residency and to practice in other states within the authority at the federal to meet their needs. Parents feel overwhelmed and
compact. Practice across state lines is allowed with or state level for collec- “Each nurse is hopeless, eventually becoming emotionally and physi-
other states in the compact unless the nurse is under tive bargaining. Howev- accountable for cally exhausted.
disciplinary restrictions. er, to the extent an indi- complying with the While there is no easy formula for healing, there is
What is an interstate compact? “An interstate vidual state believes that Nurse Practice Act.” hope for families with children in distress. A relation-
compact is an agree- the compact might facil- ship-based treatment model helps families to create an
ment between two “Primary residence is itate strike-breaking, language in the legislation can be environment for positive behavioral change. It is
or more states estab- where an individual included to explicitly state that the compact does not through the relationship between the child and parent
lished for the pur- has voter registration, supersede state labor laws. that the child’s emotional injuries begin to heal. Pro-
pose of remedying a driver’s license, or How are compacts implemented? For a state to grams are available that provide in-home therapeutic
particular problem join a compact, state legislators must enact the inter- services to help permanent families learn how to meet
federal income tax the special needs of these children.
of multistate con- state compact into state law or regulation.
cern” (Black’s Law returns delivered.” Will compacting affect Montana’s current Nurse It is well known that helping professionals, especial-
Dictionary). Practice Act? Compacting does not change the Nurse ly nurses, are
What determines primary residency for licen- Practice Act in any way. It gives additional authority for among the most “Adoption is about loss,”
sure purposes? The NCSBN established the Nurse granting practice privileges, taking disciplinary actions, successful fos- she says. “My impulse as
Licensure Compact Administrators (NLCA) to oversee and sharing information with other compacted states. ter and adoptive a nurse was to heal that
multistate compacting.The NLCA defined primary resi- Why should Montana support compacting? parents of these pain.”
dence in the rules and regulations. Primary residence is Compacting will clarify the authority to practice for special chil- Cathy Silva, RN
where an individual has voter registration, driver’s many nurses currently engaged in telenursing or inter- dren. Nurses
license, or federal income tax returns delivered. state practice. It will allow greater mobility for nurses. It have hearts for
Why join a compact and have one license for will improve access to licensed nurses during a disaster children and families, helping them to heal every day.
multiple states? One license per nurse reduces the or other time of great need for qualified nursing ser- Cathy Silva, RN, works at Intermountain, a nationally rec-
barriers to interstate practice. It improves tracking for vices. It will improve access to nursing care.And it will ognized, accredited program located in Helena that
disciplinary purposes. It is cost effective and simplifies enhance the discipline and information sharing among treats emo-
licensing. One license reduces duplication on lists of participating compact states. Note: At this time, APRN “ . . . It has been as much a tionally dis-
licensed nurses for planning and disaster preparedness. practice is not included in compacting. journey for me as it was tressed chil-
And one license facilitates interstate commerce. What about Montana Compacting? This is a time- for her. We are both richer dren. Cathy
How are varying scopes of nursing practice ly topic as the Board of Nursing is discussing compact- human beings for having
addressed? Each nurse is accountable for complying experience
ing. agreed to take the journey as a nurse
with the Nurse Practice Act in the state in which they Compiled by Barb Prescott DNP, FNP, RNC together . . . ”
provide patient care. All nurses are accountable for For further information contact www.ncsbn.org. and an adop-
Cathy Silva, RN tive parent.
practicing under a Practice Act; this is not unique to
compacting states. “Adoption is
about loss,” she says.“My impulse as a nurse was to heal
that pain. Instead, using my own life’s losses, I was able
to attune to my daughter’s pain.When I could do this, I
validated her own very unique experience of life and
she was able to bring about her own kind of healing. It
has been as much a journey for me as it was for her.We
are both richer human beings for having agreed to take
the journey together.”
How can you help? If you know families in the Great
Falls or Helena areas who have a love for kids, will open
their hearts and homes, and make a permanent com-
mitment to a child, or if you know of a family who needs
help, please contact Twila Costigan at Intermountain,
457-4845 in Helena, or 1/866-457-4859.
12”Tucson Med Center ad 12” Montana State University ad formerly Intermountain Children's Home
RESERVED - Center - Spot RESERVED - 2 Spot
April, May, June 2006—Montana Nurses’ Association Pulse—Page 13
Your Association at Work
Council on Practice and Government Affairs (CPGA)
HealthCom Media Launches New MNA Executive Director
Journal For The American Nurses Eve Franklin addresses the
Association American Nurse Council on Practice and
Government Affairs during
Today™ their April meeting.
Glenda Nielson, second from right, shares her
HealthCom Media (HCM) and the American Nurses
ideas with the rest of the CPGA members
Association (ANA) are pleased to announce the launch
during the council’s April meeting. Pictured
of American Nurse Today. Effective October 2006,
from left are Shelley Meyer, Chair, Eve Franklin,
American Nurse Today will be the official journal of
Executive Director, Lynn Hebert, Glenda, and
the American Nurses Association. Linda Henderson. Milly Gutkoski joined the
“This partnership with HealthCom Media allows ANA meeting by phone. The council reviewed Linda Henderson, member
to provide members with a publication that’s fresh and practice legislative issues facing nursing during of CPGA and MNA
innovative,” said ANA President Barbara Blakeney, MS, the coming year. Some of the major issues are President, takes on the
RN.“Our members will receive a cutting-edge periodical multi-state licensure compact, medical additional duty of secretary
every month as a benefit of membership, and ANA gains assistants, and mandatory continuing education. during the April CPGA
a partner that will help it reach the larger nursing com-
munity with important information about ANA’s advo-
cacy on behalf of the profession. American Nurse
Today will address—in depth—the many business, prac-
tical, clinical, career management, policy and legislative
issues that nurses need to keep up to date.”
“We’re excited to be working with the staff of Health-
Com Media,” added ANA Chief Executive Officer Linda
Stierle, MSN, RN, CNAA, BC.“They have a proven track Shelley Meyer, CPGA
record of partnering with organizations to produce Chair, listens intently to
high-quality publications through a business model that discussion of legislative
supports mission-driven organizations such as ANA. We issues.
believe that American Nurse Today is a win-win for Council on Practice and Government
members and the ANA.” Affairs Chair, Shelley Meyer, left, and Eve
“We are thrilled to be working with one of the most Franklin, Executive Director, share a light
important health care organizations in the country,” says hearted moment during the April CPGA
Greg Osborne, President of HealthCom Media. “The
growing informational needs of nurses demand a com-
prehensive and innovative vehicle that truly voices the
strong leadership of the organization. Nursing today is
so much more than ‘skill level,’ and American Nurse
Today not only will be the ‘voice’ of the ANA, but it also
will provide information that nurses can assimilate into
their busy careers immediately.”
The journal will be distributed monthly starting in
October 2006 to an audience of more than 150,000
members of the ANA as well as an additional 25,000
nurses in all practice settings.
The American Nurses Association is the only full-ser- 5” ads 5” ads
vice professional organization representing the nation’s OPEN OPEN
2.9 million registered nurses (RNs) through its 54 con-
stituent member associations. The ANA advances the
nursing profession by fostering high standards of nurs-
ing practice, promoting the economic and general wel-
fare of nurses in the workplace, projecting a positive
and realistic view of nursing, and by lobbying Congress
and the regulatory agencies on healthcare issues affect-
ing nurses and the public.
For more information, please contact Margaret Kay,
Periodicals Manager, American Nurses Association, at
(301) 628-5024, e-mail: Margaret.email@example.com.
10” NCSBN ad 10” United Med Center ad
RESERVED - 4 color wherever RESERVED - Spot Wherever
Page 14—Montana Nurses’ Association Pulse—April, May, June 2006
IDSA Releases Hit List of Dangerous Bugs
“Congress Must Pass Legislation to Avert Public
Health Crisis,” Group Says
WASHINGTON, DC,—The Infectious Diseases Society of America (IDSA) renewed
its call for federal legislation to galvanize the pharmaceutical and biotechnology
industries into fighting the growing epidemic of antimicrobial resistance, releasing a communities nationwide, especially where groups of people are in close quar-
“Hit List” of the six top-priority dangerous, drug-resistant microbes.These six “super- ters, including military facilities, sports teams, and prisons.The number of infect-
bugs” are especially dangerous because few or no new drugs are being developed to ed children jumped 28 percent between 2001 and 2004.
treat them. Several treatment options are available for MRSA, but many have harsh side
The Hit List was drawn from an article in the March 1 issue of Clinical Infectious effects, and resistance is growing to each of them. Most of the drugs in devel-
Diseases. opment must be given by injection—a painful, inconvenient, and expensive
“These are life-threatening drug-resistant infections, and we’re seeing them every route. Drugs that can be taken by mouth are desperately needed.
day,” says IDSA President Martin J. Blaser, MD.“What is worse is that our ammunition • Escherichia coli and Klebsiella species: These bacteria are major causes of
is running out and there are no reinforcements in sight.” urinary tract, gastrointestinal tract, and wound infections. They are becoming
Congress has not passed the comprehensive legislation needed to stimulate antimi- resistant to a growing number of antibiotic classes at the same time as the fre-
crobial research and development that IDSA called for in its July 2004 report, Bad quency of outbreaks is increasing. Failure to treat with the appropriate antibi-
Bugs, No Drugs:As Antibiotic Discovery Stagnates . . .A Public Health Crisis Brews. otics during a recently documented K. pneumoniae outbreak increased the
The new article and Hit List, written by the authors of the Bad Bugs report, re- mortality rate from 14 percent to 64 percent.
focus attention on the issue by identifying what experts in the field believe are “the Both microbes tend to rapidly evolve resistance to new drugs, but few are avail-
microbes where the gap between public health threat and drug development are the able or under development. New therapies are badly needed.
greatest,” says John G. Bartlett, MD, chair of IDSA’s Antimicrobial Availability Task Force • Acinetobacter baumannii: A. baumannii “is a prime example of a mismatch
and one of authors of the article.“These are the germs we see in hospitals every day between unmet medical need and the current antimicrobial research and devel-
that we don’t have good treatments for.” opment pipeline,” according to the Clinical Infectious Diseases article.The bac-
“These organisms are a serious threat to public health, but it’s much more prof- terium is a growing cause of hospital-acquired pneumonia. Mortality rates range
itable for a pharmaceutical company to make a cholesterol drug that you take for a from 20 to 50 percent.The number and hardiness of drug-resistant strains are
lifetime than an antibiotic you take for a week,” says George H.Talbot, MD, lead author growing. Soldiers are also returning from Iraq and Afghanistan with cases of
of the article.“IDSA is concerned that market forces are not going to solve this prob- highly resistant Acinetobacter wound infections.
lem,” he adds. Doctors have been forced to resort to an old drug, colistin, which had previ-
IDSA’s Bad Bugs, No Drugs report showed a steady 20-year decline in the number ously been abandoned as too toxic. But only one new drug is on the horizon to
of new FDA-approved antimicrobials and total withdrawal from the field by many treat Acinetobacter infections, and it is considered to be too toxic for children.
major pharmaceutical companies. • Aspergillus: This fungal infection is a growing problem among immunocom-
The authors of the report revisited the issue and found a few more drugs in the promised patients such as cancer patients, organ transplant recipients, and peo-
pipeline.“But the germs that are the biggest problems are not the ones getting the ple with HIV, and the number of infections is expected to keep increasing as the
most attention from the major pharmaceutical companies,” Dr.Talbot says.“Action is number of immunocompromised patients increases.
needed—and soon,” he adds,“because it takes years for a new drug to go from the lab Existing drugs are toxic or interact with other drugs. Resistance to them is
to the medicine cabinet.” growing. Even with the best, newly approved antifungals, death rates from
IDSA is urging Congress to pass comprehensive legislation to encourage the phar- Aspergillus infection are 50-60 percent. Few new antifungal drugs are in the
maceutical industry to re-enter this essential field. Congress should establish a com- pipeline, and their ability to combat Aspergillus infections is uncertain because
mission to set antimicrobial discovery priorities. Companies that develop novel drug companies are choosing to conduct clinical trials on other, easier-to-study
antimicrobials should be rewarded with market exclusivity rights. And research, fungal infections.
development, and manufacturing should be encouraged through tax credits. Vancomycin-resistant Enterococcus faecium (VRE): VRE is a major cause
“Investments in stimulating antimicrobials research and development will also pay of bloodstream infections, infections of the heart, meningitis, and intra-abdomi-
dividends in other areas of infectious diseases preparedness, including biodefense,” nal infections.A recent survey of 494 U.S. hospitals found a VRE rate of 10 per-
Dr. Bartlett notes.“It’s urgent that Congress make this investment now.” cent of across all patient groups. Rates are as high as 70 percent among high-
THE HIT LIST: While drugs are available to treat VRE, they have serious shortcomings. Current
• Methicillin-resistant Staphylococcus aureus (MRSA): MRSA infections drugs do not rapidly kill VRE, and only one is available in an oral formulation.
constitute the majority of health care-associated infections, increasing lengths • Pseudomonas aeruginosa: This germ causes severe infection that can be life-
of hospital stay, severity of illness, deaths, and costs.While these infections used threatening, particularly in immunocompromised patients. Rates of P. aerugi-
to be limited primarily to hospitals, they are becoming increasingly common in nosa hospital-acquired pneumonia have nearly doubled, from 9.6 percent in
1975 to 18.1 percent in 2003. Infections following surgery and urinary tract
infections from P. aeruginosa have doubled.The germ poses a particular threat
to children with cystic fibrosis (CF). Antibiotics can keep CF patients alive for
decades, but eventually highly resistant germs take over. With almost no alter-
natives left, these patients die unless they receive lung transplants.
No novel drug candidates have entered human trials. New ideas, research, and
products are desperately needed.
15”Yavapai Regional Med Ctr ad
RESERVED - 4 color wherever
April, May, June 2006—Montana Nurses’ Association Pulse—Page 15
Women, Irritable Bowel Syndrome, and Constipation National Nurses Week
Rachel Rockafellow, MSN, RN, CWOCN Laxatives work by irritating the lining of the colon Celebrated
and should be used only occasionally or as a last resort.
Who can comfortably ask someone about his or her Long-term use/abuse of laxatives can actually cause National Nurses Week was cel-
bowel movements and really care about the answer bet- damage to the lining of the intestines leading to a con- ebrated May 6-12 in honor of the
ter than a nurse? Strange topic perhaps, but problems dition called “melanosis coli.” Viewed endoscopically work of 2.9 million registered
with our bowels are common medical complaints.A for- this condition shows the lining of the colon looking like nurses throughout the United
mer co-worker, we’ll call her Sarah, had been suffering “giraffe skin” with light and dark patches indicating lax- States highlighting their role in
with diarrhea for months. At first she tried the usual ative overuse/abuse. Over time it takes more and more of providing safe, quality health
home remedies of Pepto-Bismol and Imodium without the product to get the desired result and damages the care to patients.While this week
success. As her symptoms continued, she visited her ability of the colon to was picked historically to coincide with the birthday of
doctor who tried various treatments before referring function normally. “Appreciate those Florence Nightingale, founder of the modern nursing
her to the gastroenterologists in town. The requisite One trick to help intestines and keep profession, nurses across Montana are using it as an
colonoscopy and upper endoscopy (checking out the with constipation is them in good opportunity to bring attention to the needs of citizens
digestive tract with a fiber optic scope allowing the doc- WARM prune juice. The shape!” who lack access to safe, quality health care.
tors to see and biopsy tissues along the way) were per- warm liquid stimulates “Nurses across Montana want to shine a light on the
formed to rule out disease. (These procedures are best the muscles of the colon to move things along.Another role of nursing in ensuring quality health care” stated
performed by a board-certified gastroenterologist in a product I like is called Fruit Fiber. It is made of prunes, Eve Franklin, Executive Director of the Montana Nurses’
setting used just for that purpose.) Ultimately she was dates, raisins, and prune juice concentrate and is very Association. Franklin points to two distinguished stud-
diagnosed with Irritable Bowel Syndrome or IBS. effective in increasing fiber in the diet. It is often used ies that demonstrate relationships between expert nurs-
IBS, according to the National Women’s Health Infor- in nursing homes and is only available in 5.25-pound ing care and good patient outcomes and recovery.
mation Center, is a common problem, affecting as many containers.You may want to mix a smaller batch in your • A study published in the January/February 2006
as 1 in 5 Americans with the majority being women food processor. One to two tablespoons per day (start journal Health Affairs provides new evidence that
(perhaps 75 percent). Symptoms may include constipa- slowly when increasing fiber) can do the trick. It is very if hospitals invest in appropriate Registered Nurse
tion, diarrhea, alternating constipation and diarrhea, sweet and can be used as a spread on toast or crackers, (RN) staffing thousands of lives could be saved
feeling of not being finished after a bowel movement, a sweetener in hot cereal, or plain right off the spoon. each year. Specifically the study shows that if
gas, bloating, and mucus in the stool. IBS is called a The cereal Fiber One has 14 grams of fiber in just 1/2 hospitals increased RN staffing and hours of nurs-
“functional disor- cup so that is another good source. If your symptoms ing care per patient more than 6,700 patient
der” since no sign last longer than three days, seek medical attention. deaths and 4 million days of hospital care could be
“The three cardinal rules to
of disease is While discussing bowel disorders openly may not be avoided.
avoid constipation are ade-
found on exami- comfortable for non-medical people, over the counter “This study is important because it provides con-
quate fluid intake (at least 8 crete data that proves when less costly, unlicensed per-
nation, but the sales of medications to treat these concerns indicate
cups/day), fiber, fiber, fiber just how common bowel problems are. Americans sonnel are used instead of nurses, and the nurse patient
bowel does not
work as it should. (25-40 grams/day), and spend $725 million just on laxatives in one year! ratio goes down, patients suffer and die,” emphasized
The cause is exercise (lots of it).” Meanwhile Sarah has gotten her symptoms under Kate Steenberg, RN, a Missoula emergency/flight nurse
unknown and control. She is still learning what this diagnosis means and past-President of the Montana Nurses’Association.
there is no cure. For women, symptoms may be worse for her and what she needs to do to feel well.Time and • In a study published in the Journal of the Ameri-
during the menstrual cycle so a hormonal effect cannot patience will help her get there. Among other things, can Medical Association (JAMA) in September 23,
be ruled out. Diet, stress management, and medications, she is trying a common diet nurses and other health 2003 conducted by Linda Aiken of the University
however, can usually control the symptoms. See your care providers often suggest for diarrhea called the of Pennsylvania it was determined that the educa-
health care provider if you are having symptoms of IBS. “BRAT” diet (Bananas, Rice, Applesauce, and Toast). tional level as well as the number of RNs working
Constipation is another bowel problem that is most These are foods that can thicken stools. in hospitals in bedside care has a significant
common in women and adults over age 65. It is THE Other sources of information on this topic include impact on whether patients survive common
most common gastrointestinal complaint in the Unites the International Foundation for Functional Gastroin- surgeries. There is a direct correlation between a
States with over 2 million visits to the doctor yearly testinal Disorders (www.iffgd.org or www.aboutibs.org patient receiving bedside care provided by a well-
even though it is most often treated at home. It is also or 1-888-932-2423); and the Irritable Bowel Syndrome educated registered nurse and a decrease in
common following childbirth and surgery. The official Association (www.ibsassociation.org or IBS Assoc. 1440 patient mortality.
medical definition is “bowel movements occurring less Whalley Ave, #145, New Haven, CT 06515).Your library “People with low income often suffer more serious
than three times per week.” Symptoms may also include has many different books on this topic as well covering and chronic problems due to delays in accessing health
feeling as if a bowel movement was incomplete, abdom- diagnosis, treatment (including alternative therapies), care because they do not have the kind of insurance
inal bloating or fullness, hard stools, excessive straining and a lot on diet. Just search their catalog or ask a refer- that allows them access to private providers in the com-
with bowel movement, stools that are small or insuffi- ence librarian for help. Sometimes we don’t appreciate munity,” stated Linda Henderson, RN.“The irony is that
cient in size, and difficulty or pain when passing a stool. how good we feel until something isn’t right.Appreciate middle class people suffer because they may have insur-
The three cardinal rules to avoid constipation are those intestines and keep them in good shape! ance but due to health care industry decisions they may
adequate fluid intake (at least 8 cups/day), fiber, fiber, Feel free to copy this article and use as an educa- not have access to a Registered Nurse.”
fiber (25-40 grams/day), and exercise (lots of it). Stool tional tool.
softeners, such as ducosate sodium, may help. They
work by keeping more water in the stool so it is softer
and easier to pass. I did not realize how many different
products are available until I went to purchase some for
a relative after surgery. Read the labels carefully.
10” ads 10” ads
Page 16—Montana Nurses’ Association Pulse—April, May, June 2006
Montana Nurses’ Association 2006 Annual Montana Nurses’ Association 2006 Annual
Nursing Awards Nursing Awards Nominations Form
The Montana Nurses’ Association (MNA) is pleased to announce the opening of Duplicate this form as necessary. Nominations Deadline:
nominations for the 2006 MNA Annual Nursing Awards Postmarked by July 31,
• Political Nurse Leadership Founded • MNA Historian
in Honor of Mary Munger, RN • Excellence in Nursing Education I Nominate _____________________________________________for the
• Distinguished Nurse of the Year Founded in honor of Peggy Mussehl, RN _______________________________________________________________Award.
Founded in Honor of Trudy Malone, RN (Continuing Education) and Anna
• Excellence for Advanced Practice Shannon, RN (Formal Education)
Registered Nurse of the Year • Excellence for Advanced Narrative statement detailing the accomplishments that demonstrates how the
• Friend of Nursing Founded in Honor Practice Registered Nurse established criteria was met:
of Barbara Booher Advocate of the Year
• Economic & General Welfare
Council (E&GW) Achievement
Founded in Honor of Eileen Robbins, RN
1. The nominee must be a member of the Montana Nurses’Association (except for
2. Nominations must be submitted on the form provided and mailed to the MNA
office by the deadline (July 31st). (The nomination form may be duplicated.)
3. A biographical data form or curriculum vitae that describes activities on nation-
al, state, district and other leadership levels (waived for non-nursing awards).
4. A minimum of two (2) letters of support.
5. A narrative statement detailing nominee’s accomplishments that describes com- Montana Nurses’ Association 2006 Annual Nursing
pliance with how the established criteria was met. Awards Nominations Form
6. Nomination materials received for the award will be considered confidential.
Nominee: ____________________________Award: ________________________
NOMINATION DEADLINE: Postmarked by July 31, 2006.
This nomination is for (Check One): Narrative statement (continued):
K Political Nurse Leadership K MNA Historian
K Distinguished Nurse of the Year K Excellence in Nursing Education
K Excellence for Advanced Practice (Formal and/or Continuing Education)
Registered Nurse of the Year K Excellence for Advanced Practice
K Friend of Nursing Registered Nurse Advocate of the
K Economic & General Welfare Council
Home Address: ______________________________________________________
Telephone: (w) _________________________ (h) ________________________ Signature Date
Employer: __________________________________________________________ Attachments to this Nomination Form must include:
——————————————————————— K Biographical Data Form OR K Curriculum Vitae
NOMINATOR: ______________________________________________________ K 2 Letters of Support
Home Address: ______________________________________________________
Telephone: (w) __________________________ (h) ______________________
NOMINATION DEADLINE: Postmarked by July 31, 2006.
OFFICE USE ONLY
Date Received _______________________
K Yes K No Nominee MNA Member K Yes K No Nomination Form Complete
K Yes K No Nominator MNA Member K Yes K No Narrative
K Yes K No Bio Data/CV
K Yes K No 2 Letters of Support
April, May, June 2006—Montana Nurses’ Association Pulse—Page 17
Awards Criteria NURSING STUDENT RECOGNITION
Montana Nurses’ Association 2006 Annual Nursing
O Political Nurse Leadership Award—founded O Economic & General Welfare Council (E&GW) Nominee ________________________ Selection Criteria:
in honor of Mary Munger, RN Achievement Award—founded in honor of
This award recognizes a member who has made sig- Eileen Robbins, RN
CATEGORY I: Autobiography/Vitae
nificant contributions to nursing practice and health This award recognizes nurses in local units who Address__________________________ School of Nursing: ________________
policy through political and legislative activity. A have influenced their work setting through collective
candidate must: bargaining activities. A candidate must: City, State, Zip ____________________ Year to Graduate:__________________
• Promote the nursing profession in political and • Demonstrate commitment to professional nurs-
health care arenas, ing via individual practice competency and con- Telephone ______________________ Activities & Offices held in MSNA and/or
• Advance the knowledge of nurses, politicians, tinuing educational growth, MNA: ____________________________
and policy makers concerning nursing and • Use contract language to define, monitor, and Eligibility Criteria: Read the following ________________________________
health care issues, enhance nursing practice in the work environ- and check all that apply: ________________________________
• Demonstrate political leadership at the district, ment, K Member of Montana Student Nurs-
state, or national levels, • Function as an active leader within the local unit
• Serve as a mentor and role model to other nurs-
es Assn. (date:________________) Goal(s) in Nursing: ________________
through past or present elected office and com-
es in the political process, mittee participation. K Member of Montana Nurses’ Assn. ________________________________
• Seek opportunities to advance nursing’s legisla- (date:_____________________ ) ________________________________
tive agenda through grassroots activity. K Senior student or returning RN by ________________________________
O Distinguished Nurse of the Year Award— O Excellence in Nursing Education Award— K Copy of current transcript OR CATEGORY II: Letters of Nomination
founded in honor of Trudy Malone, RN founded in honor of Peggy Mussehl, RN (Contin- K Letter of Acceptance from admit- from either faculty, nurse manager
This award recognizes a member of MNA for out- uing Education) and Anna Shannon, RN (Formal tance office and/or clinical peer which specify the
standing contributions made to professional nurs- Education) K Two letters of nomination following:
ing. A candidate must: This award recognizes a member(s) of MNA for pro- (attached)
• Demonstrate dynamic leadership in promoting fessional nurse contributions in the field of either
excellence in nursing,
K Theme Essay (attached) K Attitude
formal education and/or continuing education. A
• Demonstrate the knowledge of current issues in candidate must: K Leadership abilities
relation to the goals of the nursing profession, • Have significant involvement and commitment to Deadline: July 31, 2006 K Ability to make decisions
• Show a keen awareness and commitment to pro- advancing nursing education, Mail scholarship application portfolio to: K Ability to set priorities
fessional nursing ethics, • Expand nursing’s body of knowledge through Montana Nurses Association
• Initiate positive action toward the improvement research or other scholarly activities, 104 Broadway, Suite G-2 CATEGORY III: Submit essay focussing
of patient care, • Challenge learner to achieve optimal level of Helena, MT 59601. upon “Nurses Many Roles One Profes-
• Demonstrate the ability to work well with other accomplishment. sion”
members of the health care team. Release Authorization: (Note: This
must be signed in order for nominee to COMMITTEE USE ONLY
O MNA Award for Excellence for Advanced Prac- O MNA Award for Excellence for Advanced Prac-
tice Registered Nurse of the Year
tice Registered Nurse Advocate of the Year Category I Autobiography
This award recognizes an APRN who has demon- This award recognizes a non-APRN in Montana who
The undersigned gives the Montana (25 pts) Score: ________
strated excellence in a practice specialty area and has made a significant contribution to the state of
who has made significant contributions to health health care and/or the practice of APRNs in Mon- Nurses’ Association the absolute and
care and the professional growth of APRNs. A candi- tana. A candidate must be a/an: unqualified right to use in whole or in Category II Letters of Nomination
date must: • Community leader who has made a significant part the essay submitted for publication (30 pts) Score: ________
• Demonstrate excellence as an APRN, and as a contribution to individuals, families, communi- in the Association newsletter The PULSE.
role model for other APRNs and the nursing pro- ties and the health care system, Release authorized by: _______________ Category III Essay
fession in general, • Individual who has had a positive impact on the Signature (40 pts) Score: ________
• Be involved as a preceptor, educator, advocate in professional growth of APRNs.
the political arena,
• Have made a significant contribution to the
improvement of health care for individuals, fam-
ilies or communities,
• Be creative in his/her approach to nursing care,
• Have a positive effect on clients and colleagues,
• Utilize current research in practice.
O Friend of Nursing Award—founded in honor O MNA Historian Award
of Barbara Booher This award recognizes an MNA member who has
This award recognizes a non-nurse who has advo- demonstrated a consistent, distinct interest in nurs-
cated for and/or significantly advanced nursing in ing history. A candidate must:
Montana. The candidate must: • Participate in preservation of historical nursing
• Show significant long-term contributions made documents,
by a non-nurse to Montana’s professional nurs- • Promote interest in nursing history,
ing community, • Promote MNA’s History & Literary Endowment
• Facilitate significant accomplishments for the Fund.
Association, 22.5”ALD Website ads
• Play a key role in assisting major successes with- RESERVED
in the professional nursing community.
Montana Nurses’ Association 2006 Nursing Student
Recognition Scholarship Nomination Form
To be Completed by Nursing Instructors or Nurses in Nominations Deadline:
the Clinical Setting Postmarked by July 31,
Duplicate this form as necessary. 2006
I Nominate__________________________________________________ for the
Narrative statement detailing the accomplishments that demonstrates how the
established criteria was met:
Page 18—Montana Nurses’ Association Pulse—April, May, June 2006
Self Talk Makes a Difference without a lot of distractions. Many people find the best
time is when they first get up before they do anything
else. During the day, it might be harder to find quiet
Lynn Hebert, RN whatever you time. Review the affirmations anyway. The more you
desire. It presents a “Use personal, repeat your affirmations, the more they become part of
Three related articles in this better picture in present tense and you. It takes at least 21 days to change a habit.As these
issue have touched on the your mind. And positive language [in affirmations become part of you, you will begin to see
importance of nutrition and positive means your self talk].” opportunities to become your ideal.Then you can pick
exercise as it relates to various becoming, enjoy- what works for you, whether it be changing your eating
wellness and disease states. ing, having fun. For example,“I feel great at a body mass habits yourself or joining one of the many available pro-
Two of the most important index of 24,” or “I’m having a ball eating 4 servings of grams.
actions over which we have vegetable a day,” or “I feel terrific walking 3 miles each A couple of addendums to how you become your
control are managing our day.” ideal are how you approach a project and how you set
weight and being a non-smok- Frequently, we sabotage ourselves by talking in the your expectations.
er. We know this intellectually Lynn Hebert future or being negative. For example, the tendency is to We all approach life a little differently which is good.
and we teach our patients this principle. Unfortunately, say, “I will lose 20 pounds by my daughter’s wedding.” Some of us need much external support and some of us
we don’t always practice what we preach—to others or Let’s look a little more closely at this.Yes, it is personal. prefer the introvert approach.You may want to include
to ourselves. It has a specific and measurable goal. In many cases we your friends in your plan for a healthy, ideal you. Unfor-
There are many articles and programs on managing do need specific measurable goals.This is pounded into tunately, many times our
weight and becoming a non-smoker.This article address- our heads. Now, take a closer look at the words. “Will friends sabotage our efforts “ . . . Be realistic”
es ways to internalize changes you may wish to make or lose” is in the future. It does not picture how you want without even realizing it.
the healthy lifestyle you wish to maintain.The examples to be, but what you want to discard. Think about that. For example as you travel the path to becoming your
will be aimed at managing weight.You can use the same What do we do when we lose our car keys? We look for ideal body weight, you may hear comments such as:
ideas if you are becoming a non-smoker or you are insti- them; we find them again. And maybe we have some “You sure look great, but you have along way to go.”
tuting other good habits. extras made. Apply that thinking to “I will lose 20 (Hidden message: You’ll never make it.);“Oh come on,
First of all, make the decision that you want to be pounds by my daughter’s wedding.” Does that mean, you’ve been so witchy, you need some chocolate. (Hid-
your ideal body weight (IBW) or have a body mass “Wow, I lost 20 pounds.The wedding is over. Now I can den message: I don’t want you to look good.); or maybe
index (BMI) of 19-24. The decision is the single most find the lost weight and maybe add some more.”? the most common, “You can have just a little more.”
important action you can take. The time frame can sometimes be a deterrent to long (Hidden message: Who knows but it does sabotage a
Self talk is important when changing habits. Talk to term weight management also.The above example men- plan of healthy eating.) If you do include others in your
yourself and talk a lot. Use personal, present tense and tions “by my daughter’s wedding.” Many times we sub- plan, include only one or two, tell them your expecta-
positive language. Be specific and talk as if you are consciously use this deadline as a stopping point. So tions of them.That means you need to tell them how to
already what you are becoming. Some of you may rec- maybe it’s better to support you by telling them what does support and
ognize this as positive affirmations that were popular a “ . . . tell [your friends] omit it. For those what does not support you.
while back. They still work. how to support you by who need a dead- Finally be realistic. If you are becoming your ideal
Here are some pointers about the personal, present line, consider using body weight, you cannot plan to get there overnight and
tense and positive affirmations. Personal means I, me,
telling them what does them for mini-goals then stay there. How long did it take you to get where
my, first person. Present tense means am, enjoy, am eat- support and what as you become the you are now? You develop habits along the way. It will
ing, etc. Look at yourself as if you have already become does not support healthy you. take time to change those habits to good habits. Good
you.” So far I’ve men- habits, just like bad habits, become a way of life. So take
tioned nothing the time to change the habits.
about cutting calories or joining a program or changing Please take these tips and incorporate them into your
your eating habits. Again, the single most important own healthy lifestyle or share the information with oth-
aspect of success is the decision. So develop your per- ers.
sonal, present tense, positive affirmations. Write them (The following website, http://www.nhlbi.nih.gov/
down and review them several times a day. It’s best to do guidelines/obesity/bmi_tbl.htm, has more informa-
this when your mind is receptive to the information tion on Body Mass Index (BMI). This is from the
National Heart, Lung and Blood Institute of the
National Institutes of Health.This is only one of many
websites that address ideal body weight and BMI.You
can search for either with any search engine.)
(The “three related articles” are “From Die…t to
Nutrition” on page 19, “Teach Your Family about the
Signs of Stroke” on page 20, and “Women, Irritable
Bowel Syndrome, and Constipation” on page 15.)
April, May, June 2006—Montana Nurses’ Association Pulse—Page 19
Clinical Nurse Specialists From Die . . . t To Nutrition
in the News
Barb Prescott, DNP, FNP, RNC organ activity. Unused fuel (food) goes to storage (fat).
D. “Dale” Mayer, APRN, BC We need to balance food intake with exercise.The more
How many Americans have we move, the more fuel we need.The less we move, the
National Association of Clinical Nurse Specialists jumped on the diet band less fuel required. National recommendations for exer-
National Conference wagon only to fall off and cise have changed. It is now recommended that the
In March of 2006 the National Association of Clinical become heavier than before average adult perform sustained physical activity
Nurse Specialists held their national Clinical Nurse Spe- beginning the diet? Why are between a minimum of 30 minutes per day to 60 min-
cialist Conference in Salt Lake City, Utah. The theme of Americans having such difficul- utes per day balancing energy intake and fuel expendi-
this year’s conference was CNS Leadership: Soaring to ty in fighting the battle of the ture.
New Heights. Several nurses from Montana presented bulge? Can it be that dieters The fourth component of nutrition is sleep.The body
papers and posters accepted at this exciting confer- mainly concentrate on food builds new protein and performs maintenance activities
ence. and do not think about nutri- during REM (rapid eye movement) sleep. For adequate
tion and their health status? nutrition, the average adult requires three REM cycles
Presenters from Montana included: For many Americans the Barb Prescott per day. Each REM cycle takes approximately 90 min-
D. “Dale” Mayer, APRN, BC whose presentation was words diet and nutrition are interchangeable, but nutri- utes, however, due to dreaming and waking it generally
entitled, “Sudden Death–Support of Surviving Fam- tion is really much more.To enable the human body to takes between 7 and 9 hours per night.Thus many Amer-
ily Members and Hospital Staff.” maintain health and become well nourished, people icans are chronically sleep deprived many times by
require all of the five components of nutrition—ade- choice.
Linda Torma, APRN, BC and Charlene A. Winters, quate nutrient intake, water, exercise, sleep, and stress And finally the fifth component of adequate nutrition
DNSc,APRN, BC, CNS presented, “Heart Failure and management. is stress management. Hormones mediate our metabo-
Home Health Care: The Heart Failure Clinical Nutrition begins with food (calorie intake) and nutri- lism, wake/sleep cycles, and how we deal with our
Resource Nurse (HFCRN) Program.” ents (vitamins and minerals). Food world. It is important that both
is fuel for the body and we require “ . . . people require all of the our physical and emotional
Deanna L. Babb, MN,APRN, FNP, BC and Lynn O’Mal- intake from all of the three food
ley, MN, APRN, FNP, BC presented their paper enti- five components of nutrition— stress levels are kept at a level
groups—protein, carbohydrates, that allows for adequate nutri-
tled, “Methods to Promote Graduate Education and fat. Proteins are required to
adequate nutrient intake, tion.When we are “stressed,” we
and Nursing Research for Rural Nurses: Café Grad build, repair, and maintain body water, exercise, sleep, and have difficulty in supporting our
School.” cells and tissues. Carbohydrates stress management.” nutritional status. Stress can cre-
are required as a source of energy, ate havoc with our nutritional
The following Montana State University-Bozeman regulate nerve tissue, and are the only source of energy status.There are over 1400 chemical changes that occur
graduate student in the clinical nurse specialist tract for the brain. Fats are used to transport nutrients, are a due to the excess of stress hormones such as adrenalin.
presented the following posters at the conference: reserve source of energy, and insulate the body organs. They deplete the B vitamins, vitamin C and A, and the
Each food group has a specific function and each is mineral magnesium. They cause carbohydrate cravings
Rebecca Echeverri, RN, BSN: “Nurse Perceptions of required for optimal health. Vitamins and minerals are by lowering the levels of serotonin.
Advanced Practice Nursing: Roles, Influence, and used as part of the structure of certain proteins, help Think nutrition, not die . . . t. All of us want to be
Outcomes.” with metabolism, and add strength and integrity to tis- healthy and optimal health is an excellent goal for all of
sues and bones. us. By changing the way we view food and by thinking
For more information about NACNS, or this confer- The second component of good nutrition is water. about nutrition instead of diet, we can go a long way
ence, contact: Water is required for transport, for building new pro- toward helping us to be all that we can be—healthy and
National Association of Clinical Nurse Specialists teins, and for oxidation. For optimal nutrition, an adult happy.
(NACNS) should drink six to eight 8 ounce glasses of water daily.
(717) 234-6799 Phone However, when water is mixed with anything else, it is
firstname.lastname@example.org no longer water and does not do the job of water effi-
http://www.nacns.org ciently. One example is coffee, though made with water
it acts as a diuretic and actually reduces the amount of
Montana Association of Clinical Nurse Specialists functional water in the body.
(MACNS) The third component of nutrition is exercise. Exer-
On a related note the Montana Association of Clinical cise needs to be sufficient enough to use fuel (food)
Nurse Specialists (MACNS) is making plans for 2006.To effectively. Exercise helps distribute nutrients through-
date association bylaws have been developed, officers out the body, maintains muscle tone, and supports all
are in place, and plans for continuing education sessions
are in progress.The topic for the April 2006 meeting will
be the national CNS conference. Graduate students who
attended the national CNS conference will share their
experiences with the group.There will also be time for 15” ads
CNSs and other interested nurses from across the state OPEN
of Montana to network on topics and issues related to
advanced practice nursing.
The chapter is recruiting new members. For informa-
tion about this chapter contact:
Charlene Winters, DNSc,APRN, BC
Montana State University-Bozeman, College of
Page 20—Montana Nurses’ Association Pulse—April, May, June 2006
Teach Your Family About the Signs of a Stroke
Rachel Rockafellow, MSN, RN, CWOCN head, and say a complete sentence. If they have difficul-
ty with these tasks, take the person to the emergency
Babette “Babs” Truex had a room for evaluation.
stroke at the young age of 50. Risk factors for stroke include high blood pressure,
As a certified medical assistant tobacco use, diabetes, and carotid or other arterial dis-
she knows the signs and symp- ease, atrial fibrillation, other heart disease, TIAs, high
toms of a stroke, yet when she blood cholesterol, physical inactivity and obesity, exces-
was experiencing them her- sive alcohol, some illegal drugs, increasing age, gender, In Bab’s case, they were unable to determine the
self, she did not have the abili- heredity and having had a prior stroke or heart attack. cause of her stroke and speculated a piece of plaque
ty to identify what was hap- Some of these we can’t do much about, but others we from one of her arteries broke off and caused blockage
pening. According to the can. Back to lifestyle, lifestyle, lifestyle—there are no of blood to the brain.Within a few days Babs was trans-
American Heart Association quick and easy fixes. Only you can modify your risk fac- ferred to St. Vincent Healthcare New Hope Rehabilita-
(AHA), on average someone in tors by being aware and then taking action to change tion/Headway in Billings to work on regaining the use
the United States (US) has a Rachel Rockafellow those things you can. of the right side of her body and ability to speak and
stroke every 45 seconds; some- Because Babs was not her usual self, she thought she swallow. She arrived in a wheelchair unable to walk.
one dies from a stroke about every three minutes. Each was experiencing the flu. She rested in bed a whole day When the team of
year about 500,000 people will have their first stroke not recognizing her symptoms (nausea and jerky body doctors, nurses,
movements, inability to lie
“If you have risk
and 200,000 have recurrent and therapists
strokes. The AHA claims still and thinking it was from entered her room factors for a stroke, do
“Ask the person to smile, raise both restless leg syndrome or what you can to
46,000 more women than to devise a plan of
men have a stroke each year, hands over their head, and say a being sick). It wasn’t until care, she told decrease your odds of
yet in another piece of their complete sentence. If they have dif- later in the day when she them to work her having one.”
literature, they claim strokes ficulty with these tasks, take the tried to turn on the televi- very hard because
are more common for men. person to the emergency room for sion that she realized she she planned on walking out of there unassisted in two
Go figure . . . In any case our evaluation.” couldn’t use her right hand weeks to be with her son for the arrival of her new
gender is not something we very well. It was about that grandson.The team was skeptical as the usual stay there
can easily change! However, the estimated direct and time her husband came home from work and found she is two to three months. She had an intense rehab sched-
indirect cost of a stroke in the US for 2006 is $57.9 bil- wasn’t speaking clearly either. They called her doctor, ule all day long every day she was there and did manage
lion! who advised them to go to the emergency room right to walk out of the facility in two weeks. She believes her
American Heart Association statistics show that 88 away. strong faith in God and the prayers of her family and
percent of the strokes are “ischemic,” meaning a lack of Often people don’t recognize the signs of a stroke friends pulled her through.
blood flow, usually from a blood clot; 9 percent are from and think they’ll just go to bed and be better in the Babs went home and continued physical therapy in
“intracerebral hemorrhage,” which means one of the morning. By morning it is often too late to do anything Bozeman finding everything to be exhausting.What was
blood vessels breaks or bursts and bleeding in the brain and the damage may be permanent. If someone experi- previously a simple task now required concentration
occurs; and 3 percent are from a subarachnoid hemor- encing stroke symptoms goes to the emergency room and work to achieve and left her needing to rest. She
rhage, which is bleeding between the brain and the immediately, the sooner a CT scan is done to determine was out of work for three months and then returned for
membrane that covers it causing pressure to the brain the cause of the stroke (clot or bleed), the sooner treat- just three days a week. In her words,“there is nothing
itself and therefore tissue damage.With one of every 15 ment can pre- like a brush with death to rearrange priorities.” She now
deaths in the US in 2003 being from a stroke, it ranks as vent permanent “ . . . lifestyle—there are focuses on spending more time with her family. She
the number three killer behind heart disease and can- damage to the no quick and easy fixes. feels the experience has made her more humble, empa-
cer. brain. Remem- Only you can modify thetic, and caring. She is careful about her balance and
About 15 percent of strokes are preceded by a “tran- ber, 88 percent occasionally has to concentrate on her words; however,
sient ischemic attack” or TIA, which has similar symp- of strokes are
your risk factors.”
people meeting Babs today (four years later) would not
toms of a stroke: weakness on one half of the face or from a clot. If easily realize she has had a stroke. She has been fortu-
body,“aphasia” or inability to express themselves verbal- the clot can be dissolved and blood flow and oxygen nate indeed. She agreed to be interviewed for this arti-
ly, loss of vision in just one eye, loss of some of their return to the injured brain tissue soon enough (within cle with the hope that it may help others avoid what
senses on one side of the body, or sudden loss of bal- three hours of first symptoms), there may be no residual she has experienced. If you have risk factors for a
ance. Anyone with these symptoms should seek imme- damage from the stroke.This is why it is critical for peo- stroke, do what you can to decrease your odds of hav-
diate emergency medical care.A friend reminded me of ple to understand the symptoms and get help as soon as ing one.Teach the people you love about the signs and
a layperson’s assessment that has gone around the inter- possible. symptoms of a stroke so they will get emergency care
net:Ask the person to smile, raise both hands over their as soon as symptoms appear. Don’t delay! Stay healthy.
12” ads 12” ads
6”ALD Strange Codes ad
April, May, June 2006—Montana Nurses’ Association Pulse—Page 21
Develop a Disaster Plan for Your Family through the Federal Emergency Institute. Glenn Puffer
at Montana State University has been very helpful to
Jason in getting these programs going so our communi-
Rachel Rockafellow, MSN, RN, CWOCN ty has the resources it needs to respond to whatever
comes our way.The course is 20 hours over three days
During the last year the world has had many natural and trains people in the skills they need to be effective
disasters. Our hearts go out to those who have lost so in an emergency such as basic firefighting, first aid, extri-
much.While we in Montana are not at risk from a hurri- cation training (how to escape confined structures safe-
cane, there are natural disasters we sometimes underes- ly), etc. He highly recommends this program as well as
timate right here at home. It is not that long ago that we the American Red Cross (ARC) Disaster Action Teams
felt the earthquake that fortunately did not cause great (DAT). People can volunteer with ARC to respond local-
damage in our area, although the possibility of a large ly, nationally, and internationally. The local DAT team
earthquake is still quite real. Some days in the Gallatin responds whenever there is a house fire and people
Valley the views of the mountains were barely discern- need clothing and shelter until their insurance or other
rupt utilities and power for a considerable length of
able through the smoke from the forest fires. During the help kicks in.
time. People need to be able to stay in their homes safe-
winter months, we get big snowstorms. In looking at the The Gallatin County Public Health Department has
ly for at least 72 hours. In general your kits should
Montana Extension Disaster Education Network (EDEN) also been coordinating with Jason’s work so adequate
include water, easily prepared food, a first aid kit, pre-
website http://montanahelp.org/, some of the natural medical personnel can respond in emergencies. Jason
scription medications, and important papers in a water-
disasters they recommend being prepared for include: feels we are fortunate to have “one of the most proactive
proof container. The fact sheets on the city website
avalanche, cold and winter weather, earthquake, flood, health officers in the state” in Stephanie Nelson.
(www.bozeman.net/des) provide more specifics.
fire, landslides, radiological accidents, and tornadoes. A No one knows what emergencies we may face, but
Another way to be prepared is to develop a plan with
few years ago there was a train derailment of a poiso- having a plan can be the best bet for emerging from the
your family of what you would do under differing cir-
nous gas in northwest Montana that required evacua- other side in good shape. The Disaster and Emergency
cumstances (parents at work, children at school, etc.)
tion of the area. Services of Montana handout summarizes it best:
and review it every six months. Arrange for an agreed
The biggest thing about disasters is we don’t have 1. Discuss the disasters most likely to happen in your
upon out of area contact in case local communication is
much or any warning. Even when we have a plan, it may area and their impact on your family’s safety
not match up with how the event occurs. Fortunately, (home fires, severe winter weather and storms,
Firefighter Shrauger feels a big problem in New
Gallatin County/City of Bozeman has Jason Shrauger, earthquakes, floods, and hazardous materials
Orleans was that people were unable to get information
Deputy Gallatin County Emergency Manager addressing threats).
from emergency planning personnel on what they
these issues. He has a joint appointment between the 2. Train all family members in first aid, how to use
should do. If there were an emergency in Gallatin Coun-
city and county, and works as a fire fighter at the North fire extinguishers, how to turn off the natural gas
ty, his department would announce information for the
Rouse station. Jason views these emergencies from two at home if needed.
public at the website listed above (no help if power is
perspectives: the emergency manager of the county and 3. Assemble a 72-hour emergency preparedness kit
out); on 1600 AM and 1700 AM radio stations, and a fre-
as a firefighter. In his on-the-job experience the biggest (enough food, water, clothing, and medications for
quently updated recording would play at 582-3175. He
problem he sees is people not being prepared to sup- each family member).
can also activate the NOAA weather radio system (the
port themselves and their family independently for 72 4 Identify in and out of state emergency names and
radios that will sound
hours. He recommends having a 72-hour kit that is numbers and provide copies to each family mem-
an alarm to wake peo-
updated every 6 months, not just at home, but also at ple if there is an “ . . . Be prepared . . . ber. Post a copy near your phone and put copies in
work, and in the car.The kit at home may be larger with maintain a 72 hour your 72-hour disaster supplies kit.
heavy sleeping bags and a gas grill, while the one at emergency kit . . .” 5. Maintain your readiness. Review your disaster plan
emergency). For those
work or in the car may be smaller until you can get with your family at least once a year. Identify what
who have a cell
home (if you can get home). One of Jason’s worst-case new training, equipment, or supplies you may
phone, they can go to http://emergencye.com/ to regis-
scenarios for our county is an earthquake that could dis- need (rotate that food and water every 6 months).
ter their phone. Once registered, if there were an emer-
Conduct fire evacuation and earthquake drills
gency, they would receive a text message from the
with your family.
department of emergency management in Gallatin
No one wants to experience anything like what hap-
County. You would also hear announcements on the
pened in New Orleans or other natural disasters.We can
radio and television by the emergency alert system (you
make the difference by being prepared for whatever
know those tones you hear monthly to be sure the sys-
Mother Nature throws our way. Check your city or coun-
tem is working properly). Find out who the emergency
ty website for more information pertaining to your area.
planning personnel are in your county, and what they
Currently there are local citizens taking the Citizens
15” ads Emergency Response Team (CERT) training offered
Page 22—Montana Nurses’ Association Pulse—April, May, June 2006
Montana Nurses’ Association
104 Broadway, Suite G2 • Helena, MT 59601 • 406/442-6710 • 406/442-1841 Fax
__________________________________________________ ________________________________ ________________________
Last Name/First Name/Middle Initial Home Phone Number Social Security Number
__________________________________________________ ________________________________ ________________________
Credentials Work Phone Number Basic School of Nursing
__________________________________________________ ________________________________ ________________________
Preferred Contact: Home _____ Work_____ Fax Number Graduation (Month/Year)
__________________________________________________ ________________________________ ________________________
Home Address Date of Birth RN License Number/State
DISTRICT CONTACTS __________________________________________________
District 1 __________________________________________________ _____ UAN Member? _____ Not a Member of Collective Bargaining Unit
Meetings every first Tuesday of
the month September through __________________________________________________ ____________________________________________________________
April at CMC–for more informa- Employer Name Member of Collective Bargaining Unit other than UAN? (Please specify)
tion contact: ________________________________________________________________________________________________________________________
Cindy Bumgardner Employer Address
Home—(406) 728-7954 ________________________________________________________________________________________________________________________
Work—(406) 728-4100 Employer City/State/Zip Code
Membership Category (check one) Choice of Payment (please check) Check (payable to ANA)
E-Pay (Monthly Electronic Payment)
M Full Membership Dues This is to authorize monthly electronic pay- Visa MasterCard
Employed - Full Time ments to American Nurses Association, Inc.
Employed - Part Time (ANA). By signing on the line, I authorize my Automated Annual Credit Card Payment
District 2 Constituent Member Association (CMA/ANA ) This is to authorize annual credit card pay-
R Reduced Membership Dues to withdraw 1/12 of my annual dues and any ments to American Nurses Association, Inc.
Joanne Green Not Employed additional service fees from my account. (ANA). By signing on the line, I authorize
Home—(406) 495-9382 Full Time Student CMA/ANA to charge the credit card listed in
New graduate from basic nursing Checking: Please enclose a check for the the credit card information section for the
Work—(406) 723-5816 education program, within six months first month’s payment; the account annual dues on the 1st day of the month
after graduation (first membership when the annual renewal is due.
designated by the enclosed check will be
Joanne Green drafted on or after the 15th of each month.
62 years of age or over and not
earning more than Social Security Credit Card: Please complete the credit __________________________________________
allows card information below and this credit card Annual Credit Card Payment Authorization
will be debited on or after the1st day of Signature
S Special Membership Dues each month.
62 years of age or over and not Payroll Deduction
District 3 This payment plan is available only where
Keven Comer Totally disabled Monthly Electronic Deduction Authorization there is an agreement between your employ-
Home—(406) 587-4989 Signature er and the association to make such deduc-
Work—(406) 582-8957 Full Annual Payment __________________________________________
Please Note: Signature for Payroll Deduction
$5.42 of the CMA member dues is for sub- Membership Investment _______
Keven Comer scription to The American Nurse. $16 is for ANA-PAC (Optional—$20.04 Please mail your completed application with
subscription to the American Journal of suggested) _______ payment to your STATE NURSES ASSOCIATION
Nursing. Various amounts are for subscrip- Total Dues and Contributions _______ or to:
tions to CMA/DNA newsletters. Please check Montana Nurses’ Association
with your CMA office for exact amount.
Online: www.NursingWorld.org (Credit Card 104 Broadway, Suite G2
District 4 Only) Helena, MT 59601
State nurses association dues are not
Brenda Donaldson deductible as charitable contributions for tax
* By signing the Monthly Electronic Deduction
Home—(406) 442-0681 purposes, but may be deductible as a business
Authorization, or the Automatic Annual Credit Card
expense. However, that percentage of dues CREDIT CARD INFORMATION
used for lobbying by the CMA is not Payment Authorization, you are authorizing ANA
deductible as a business expense. Please to change the amount by giving the above-signed
__________________________________________ thirty (30) days written notice. Above signed may
check with your CMA for the correct amount.
Brenda Donaldson Bank Card Number and Expiration Date cancel this authorization upon receipt by ANA of
written notification of termination twenty (20) days
__________________________________________ prior to deduction date designated above. Mem-
Authorization Signature bership will continue unless this notification is
District 5 received. ANA will charge a $5 fee for any returned
Tina Hedin __________________________________________ drafts or chargebacks.
Work—(406) 657-4150 Amount: $__________________________________
TO BE COMPLETED BY CMA:
Employer Code _________________________
__________ __________ ___________ Sponsor, if applicable ____________________
STATE DIST REG Approved By _____________ Date _________
District 6 SNA membership # ______________________
Pam Windmueller Expiration Date ________ / ________ $ ____________________________________
Home—(406) 771-7453 Month Year AMOUNT ENCLOSED CHECK #
M E M B E R S H I P A P P L I C A T I O N
Angela St. John
District 8 6” ads 6” ads
Vacant OPEN OPEN
April, May, June 2006—Montana Nurses’ Association Pulse—Page 23
I DON’T KNOW YOU. I DON’T WANT ANYTHING FROM YOU.
BUT I WILL GIVE YOU MY BLOOD.
When you help the American Red Cross, you help America.
We all have to look out for each other. And with an American needing blood
every two seconds, someone needs you to roll up your sleeve now.
Call 1-800-Give Life or visit us at givelife.org
45”ALD Website ad
RESERVED - 4 color
Page 24—Montana Nurses’ Association Pulse—April, May, June 2006
22.5”ANA Credentialing Center ad 22.5” ads
RESERVED - 4 color OPEN
22.5” Samuel Simmonds ad 22.5”Benefis Health Care ad
RESERVED - 4 color RESERVED - 4 color wherever