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					                                                                                     The Pulse
   THE OFFICIAL                    President’s Message                                                       Executive Director
                      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 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
             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?
                                                                                                                            MARK YOUR
                         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-
                                                                                                          MNA 94th
  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!
                                                                                                                                                  Presort Standard
                                                                                                                                                    US Postage
                                                                                                                                                    Permit #161
                                                                                                                                                   Princeton, MN
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:
lective-bargaining related activi-                               activities.                                                                       Website:
                                                                                                                                                 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-
                                                                                                                                Editorial Board:
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
                                                                        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
                                                                                          RESERVED                              advertisement.
                                                                                                                                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

                  Labor Relations
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.

                                                                                                                                                     5” ads

                                                                                     10” ads


   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

                                                               Labor Relations
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
                                                            actions?”                                                      nursing.
                                                               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?

                                                                                        8” ads

                                                                                                                                                       6” ads
                                                                                                      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 and artlynn@ Emailing is the preferred way for article sub-     Eve Franklin, MNA Executive Director, Editor    
missions but you may certainly mail in articles also to:        Jolene Devine,Assistant Editor                  
Montana Nurses’ Association, 104 Broadway, Suite G-2,           Editorial Board Members:
Helena, Montana 59601.                                                Lynn Hebert, Chair                        
   If writing intimidates you, or even if it doesn’t, you             Barb Prescott                             
can call the MNA Office for assistance.We want to share               Mary Pappas                               
your information with other nurses in Montana. Pulse                  Rachel Rockafellow                        
articles are reviewed by a committee of your peers and                Mae Rittal                                
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
                                                                                        OPEN                                                        OPEN

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                               22.5”Travel 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

                                                                    Continuing Education
Are We Ready For Mandatory Continuing Education?                                                                         B. a national certifying body
                                                                                                                            requirement.These include:
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
                                                                                               - Radiology
      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
                                                                                               - Sanitarian
                                                                - Clinical Lab                                              • Montana Geriatric Education Center, Missoula
                                                                                               - Clinical Profes--
                                                                   Scientist/Specialist                                     MNA represents nurses in most major hospitals as
                                                                                                   sional Counselor
                                                                - 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:
                                                                                                   ologist Aide
                                                                - Clinical                                                 1) Compensation for mandatory in-service is at the
                                                                                               - Speech/Language
                                                                   Psychologist                                                nurse’s regular rate of pay unless the Hospital
                                                                                                                               requires attendance at a time that results in over-
                                                                                               - Teacher
                                                                Or                                                             time.
                                                                                                                                                             (continued on page 5)

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                                                                                                   April, May, June 2006—Montana Nurses’ Association Pulse—Page 7

                                                                  Continuing Education
     Are We Ready for Mandatory
        Continuing Education?                                 CE CALENDAR
                 (continued from page 4)                      Reference     Date           Workshop                                           Location         Contact
                                                              Number                                                                                           Hours
 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,
   mandatory CE?
                                                                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
    and retention.
                                                            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
                                                            our organization.
    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
    educational opportunities.
  • 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 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!

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                                                                                                                                            6”ALD Strange Codes ad

                                                                                                        April, May, June 2006—Montana Nurses’ Association Pulse—Page 9

                                                                            Student Corner
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
                                                                                                                                     state compact.
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
                                                                                                                                     expert services.
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 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                                                    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
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.

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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
                                                                                                                                                                            speaks from
   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                                                             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.

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                                                                                                      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:

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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-
                                                                                                  risk groups.
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.

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                                                                                                       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 ( or                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 ( 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.

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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

                              Nomination Procedure

  1. The nominee must be a member of the Montana Nurses’Association (except for
     non-nursing awards).
  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
                                              (E&GW) Achievement

  NOMINEE: _________________________________________________________

  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

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                                                                                                                            April, May, June 2006—Montana Nurses’ Association Pulse—Page 17
                   Awards Criteria                                                                                         NURSING STUDENT RECOGNITION
   Montana Nurses’ Association 2006 Annual Nursing
                                                                                                                                                     Application Form
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
                                                                                                                    be judged.)
                                                            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
   ________________________________ Award.

   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,
                                                           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
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                                                                                                                           Bowel Syndrome, and Constipation” on page 15.)

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                                                                                                     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                                         no longer water and does not do the job of water effi-                                   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
      (406) 243–4608
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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
                          OPEN                                                          OPEN

                                                                                                                                           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, 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.
                                                             ( 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.
                                                             approaching weather
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 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
                                                                                                                        Stay safe!
                                                                 Currently there are local citizens taking the Citizens
                          15” ads                            Emergency Response Team (CERT) training offered

                                                                                       12” ads

                                                                                                                                                      11” ads
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
                                                                                                                                                   DATE       ________________________________

                                                            __________________________________________________                   ________________________________               ________________________
                                                            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                                           __________________________________________________
                                                            Home Address

   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)
                                     Cindy Bumgardner
                                                                                                            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
                                                                year only)
  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
                                                                employed                                  __________________________________________
  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: (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.
                                                                                                         Printed Name
  Home—(406) 656-9632
  Work—(406) 657-4150                                                                                    Amount: $__________________________________

                                        Tina Hedin
                                                        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 #

                      Work—(406) 455-5375

                                                              M E M B E R S H I P                                                   A P P L I C A T I O N
Pam Windmueller

  District 7
  Angela St. John
  (406) 892-1003

  District 8                                                                              6” ads                                                                        6” ads
  Vacant                                                                                  OPEN                                                                          OPEN
                                             April, May, June 2006—Montana Nurses’ Association Pulse—Page 23

                                                        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

                            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

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