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Official Newsletter of New Hampshire Nurses Association Quarterly publication direct mailed to approximately 23,000 Registered Nurses, LPNs, and LNAs in New Hampshire.

July 2016 www.NHNurses.org Vol. 40 No. 3

Navy Nurse Honored with Vietnam VetsAnn Darby Reynolds of Exeter, one of the first women in the Navy to receive a Purple Heart in the Vietnam War, was among dozens of Vietnam veterans honored at a breakfast April 25, 2016, commemorating the 50th anniversary of the war held at the Veterans Administration Medical Center. The commemoration extends from Memorial Day 2012 through Veterans Day 2025. One of its objectives is to thank Vietnam veterans, including prisoners of war and those listed as missing in action, for their service and sacrifice on behalf of the United States.

Reynolds graduated in 1961 from St. Anselm College and arrived in Vietnam in February 1964. She was the youngest Navy Nurse at the Station Hospital Saigon. Her story has been chronicled on the Naval History blog (www.navalhistory.org); and featured in the Navy Magazine “All Hands” in March 2011 (http://www.moaa-nh.org/All_Hands_Mar_11.pdf)

Lieutenant (junior grade) Ann Darby spent much of her time in Saigon working late night shifts in the surgical ward or the intensive care unit. When she wasn’t treating the wounded, she was marching up and down the hotel’s five flights of stairs delivering food to patients. Even on her days off, Darby devoted precious time hunting down scarce hospital supplies at various Saigon apothecaries, often paying for items with her own money.

Reynolds shared an apartment with three other nurses in the Brink Bachelor Officers Quarters (BOQ) – a drab seven story hotel leased by the Navy to provide housing for American officers in Saigon. Commander Ann Richman, the head nurse, instructed Navy nurses to always travel in pairs and never leave their quarters after dark. “We heard that they had a price on the heads of the medical personnel,” Reynolds later told an historian, “A nurse was worth $25 dollars and a physician was worth $50.”

On Christmas Eve, 1964, Reynolds stood in her living room and gazed across the street hoping to see Bob Hope, who had just arrived in town for his annual Christmas tour. She had her face pressed against a

French door when a 200-pound bomb in a panel truck went off in the Brink’s garage. The door blew into the room and glass broke on top of Reynolds, cutting her in the leg. Since she was on call that evening, her first thought was, “Oh boy. Hospital OR [operating room] call. Here we go!” Dazed, Reynolds tried to go to her bedroom to retrieve her sneakers but was ordered to evacuate by another officer. She noticed fire and smoke as she made her way to the building’s courtyard, and then tried to assist the victims. When the ambulances arrived, she got into the first one and took some patients to the hospital six miles away. Reynolds had no idea she was bleeding until a corpsman said, “You need to be sutured so I am putting a suture set aside for you.” Reynolds worked on patients until everyone was taken care of before requesting that her leg be examined.

Reynolds continued when interviewed by The Union Leader noted “I was going on adrenaline. I was focused and went right down to the operating room with those two patients,” she said. The rest of the hospital staff came in behind her and all went to work. As she was being treated, another patient, who she knew from mealtimes in the cafeteria, was put beside her. “He didn’t survive,” she said, her eyes tearing up. “I still remember his last words – ‘Don’t let me die.’ That was Christmas morning. That was not a good Christmas.”

The Brink BOQ bombing destroyed three floors of the building, killing two U.S. servicemen and injuring 63 Americans, an Australian Army officer, and 43 Vietnamese civilians. Four Navy nurses in the building, including Reynolds, were wounded in the attack and each one insisted on treating victims at the scene and helping with disaster response before tending to their own injuries. In recognition of being injured during war and for her courageous service to our country, Reynolds was one of four Navy nurses who received the Purple Heart during the Vietnam War.

Reynolds remained in Vietnam until March 1965. She continued her Navy career earning the senior rank of Captain and serving as the Chief Nurse at several Naval Hospitals. She retired in 1988 serving for over 26 years. In 2013 St. Anselm’s awarded Reynolds the Alumni Award of Merit for her life-long devotion to the nursing profession and for providing quality health care.

On May 13, 1908, President Theodore Roosevelt signed the Naval Appropriations Bill, establishing the Nurse Corps as an essential component of the Navy. Since then, the men and women of the Nurse Corps have served in times of peace and war, at home, overseas and on the front lines. From the first Navy nurses in 1908, to 4,200 Navy nurses serving today, the Nurse Corps has answered the call, often at great sacrifice, to care for those entrusted to us when they need us most. In 1921, 11 Navy Nurses became the first military women to serve aboard a hospital ship, the USS Relief. In 1972, a Navy nurse, Alene Duerk, was the first woman in the Navy to achieve flag rank. An integral part of the Navy Medicine team, Navy nurses fly with wounded; provide care for the fleet and aboard hospital ships; establish nursing schools, clinics, and small hospitals in remote locations; and serve in military treatment facilities worldwide. Navy nurses are scientists, teachers, researchers, providers and clinicians and are essential to force health protection and readiness.

– Taken from a 108th Birthday Salute from Vice Admiral Forrest Faison, Surgeon General

Ann Darby Reynolds

Navy Nurse Honored . . . . . . . . . . . . . . . . . . . . 1

Report from Governor’s Commission . . . . . . . . 2

President’s Message . . . . . . . . . . . . . . . . . . . . 3

Save the Date! . . . . . . . . . . . . . . . . . . . . . . . . 3

PPI and Clostridium Difficile Infection . . . . . 4-5

In My Opinion . . . . . . . . . . . . . . . . . . . . . . . . . 6

This Month in Nursing History . . . . . . . . . . . . . 7

From the Bookshelf . . . . . . . . . . . . . . . . . . . . . 7

In Memory of Our Colleagues . . . . . . . . . . . 8-9

KUDOS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Eta Iota Sigma Theta Tau Chapter News . . . . 10

Humor Me . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Welcome New and Returning Members . . . . . 11

School News . . . . . . . . . . . . . . . . . . . . . . . . . 12

NCLEX Reconsidered . . . . . . . . . . . . . . . . . . 13

Student Nurse Conference 2016 . . . . . . . . . . 14

Letters to the Editor . . . . . . . . . . . . . . . . . . . 15

Board of Nursing News . . . . . . . . . . . . . . . . . 17

What Does 72 Cents Buy in 2016 . . . . . . . . . 19

Membership Application . . . . . . . . . . . . . . . . 19

Page 2 • New Hampshire Nursing News July, August, September 2016

NURSING NEWSVol. 40 No. 3Official publication of the New Hampshire Nurses’ Association (NHNA), a constituent member of the American Nurses Association. Published quarterly every January, April, July and October. Library subscription rate is $24. ISSN 0029-6538

Editorial OfficesNew Hampshire Nurses Association, 25 Hall St., Unit 1E, Concord, NH 03301. Ph (603) 225-3783, FAX (603) 228-6672, E-mail office@NHNurses.org

Editor: Susan Fetzer, RN, PhD

NHNA StaffFaith Wilson, Office Manager

NURSING NEWS is indexed in the Cumulative Nursing Index to Nursing and Allied Health Literature (CINAHL) and International Nursing Index.

For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, sales@aldpub.com. NHNA and the Arthur L. Davis Publishing Agency, Inc. 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 advertisement.

Acceptance of advertising does not imply endorsement or approval by the New Hampshire Nurses Association of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. NHNA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of NHNA or those of the national or local associations.

MISSION STATEMENT

NHNA, as a constituent member of the American Nurses Association, exists to promote the practice, development and well being of NH nurses through education, empowerment and healthcare advocacy.

Adopted 10-20-2010.

NH Nursing News (NHNN) is the official publication of the NH Nurses’ Association (NHNA), published quarterly – and available in PDF format at our website: www.nhnurses.org Views expressed are solely those of the guest authors or persons quoted and do not necessarily reflect NHNA views or those of the publisher, Arthur L. Davis Publishing Agency, Inc. NHNA welcomes submission of nursing and health related news items, original articles, research abstracts, and other pertinent contributions. We encourage short summaries and brief abstracts as well as lengthier reports and original works. An “article for reprint” may be considered if accompanied by written permission from the author or publisher. Authors do not need to be NHNA members.*

Manuscript Format and Submission:Articles should be submitted as double spaced WORD documents (.doc format vs. .docx, please) in 12 pt. font without embedded photos. Photos should be attached separately in JPG format and include captions.

Submissions should include the article’s title plus author’s name, credentials, organization / employer represented, and contact information. Authors should state any potential conflict of interest and identify any applicable commercial affiliation. Email

as attachments to office@nhnurses.org with NN Submission in the subject line.

Publication Selection and Rights:Articles will be selected for publication based on the topic of interest, adherence to publication deadlines, quality of writing and peer review. *When there is space for one article and two of equal interest are under review, preference will be given to NHNA members. NHNA reserves the right to edit articles to meet style and space limitations. Publication and reprint rights are also reserved by NHNA. Feel free to call us any additional questions at 603-225-3783.

Advertising:Product, program, promotional or service announcements are usually considered advertisements vs. news. To place an ad, contact: Arthur L. Davis Publishing Agency, Inc. Email sales@aldpub.com or call 800-626-4081. Ad sales fund publication and mailing of NH Nursing News and are not paid to NHNA.

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VISION STATEMENT

Cultivate the transformative power of nursing.

Adopted 10-20-2010.

Report from Governor’s CommissionEd Note: Todd Gardner is the NHNA Representative to the Governor’s Commission on Alcohol and Drug Abuse Prevention, Intervention, and Treatment. He submitted this report to the Board of Directors during the April, 2016 meeting.

The April 22, 2016 session began with the introduction of James Vara of New London, Governor Hassan’s newly appointed Advisor on Addiction and Behavioral Health. As the newest member of the Commission, Vara plans to meet with each Commission member individually in the coming weeks to better understand our work.

The NH Human Trafficking Work Group presented a report on their ongoing work. The group’s mission is to develop and implement a coordinated and collaborative, victim-centered, trauma-informed, multidisciplinary response to human trafficking in New Hampshire. The group’s main goals are identifying trafficking victims, investigating and prosecuting, and providing comprehensive, victim-centered, trauma-informed services to support all survivors. It is recognized that human trafficking is often perpetrated by a person coercing the victim into performing sexual acts in exchange for drugs. The victims suffer from sexual trauma and the resulting drug addiction and the perpetrator controls both. I offered that survivors of human trafficking

and addiction need readily available, highly trained, trauma-informed clinicians to guide their recovery and that the lack of support, incentives, or adequate compensation for social workers and mental health counselors in this state is concerning.

The Department of Health and Human Services gave a status report on New Hampshire’s Medicare and Medicaid Section 1115 Research and Demonstration Transformation Waiver.

On January 5, 2016 the Centers for Medicare and Medicaid Services (CMS) approved New Hampshire’s Section 1115 Research and Demonstration Transformation Waiver, #11-W-00301/1 to access new federal funding to help transform its behavioral health delivery system.

The Transformation Waiver has four main targets:• Deliver integrated physical and behavioral

health care that better addresses the full range of individuals’ needs

• Expandcapacity to address emergingandongoingbehavioral health needs in an appropriate setting

• Reduce gaps in care during transitions acrosscare settings by improving coordination across providers and linking patients with community supports.

• Move fifty percent of Medicaid reimbursementto alternative payment models by the end of the demonstration period

By providing funding to support delivery system transformation—rather than to cover the costs of specific services rendered by providers—the waiver

will enable health care providers and community partners within a region to form relationships focused on transforming care. This funding will also provide prompt resources for combatting the opioid crisis and strengthening the state’s strained mental health delivery system. For more information on Waiver 1115: http://www.dhhs.nh.gov/section-1115-waiver/index.htm

There was a brief legislative update. The status of the following current opioid related legislation can be searched at: http://www.gencourt.state.nh.us/bill_status/quick_search.html

SB 485 SB 369 SB 576 HB 1423

HB 1681 SB 523 SB 522 SB 430

HB 1619 SB 447 SB 532 HB 270

HB 1210 SB 533 HB 271 SB 464

The session closed with brief Task Force reports and public comments.

The Health Care Task Force presented some ongoing development of strategies to reduce substance related harm including; opioid prescribing best practice education and online clinical tools, Screening, promotion and standardization of Brief Intervention, and Referral to Treatment (SBIRT) substance use intervention model, and promoting nhtreatment.org awareness. The need for embedded mental health counselors in health care clinics is an identified need.

I am pleased to report that several commission members have read, or are currently reading, Chasing the Scream: The First and Last Days of the War on Drugs by Johann Hari – including Governor Hassan!

Todd S. Gardner BSN, RN is a Behavioral Health Coordinator on the Behavioral Intervention Team at Dartmouth Hitchcock Medical Center

CALLING ALL RNs & LPNs!Looking for a change? How about sharing your knowledge and skill by teaching LNA classes!

We are currently hiring Nurses to teach per diem, who meet the following criteria:

• Min. 2 years experience in long term care• Positive and enthusiastic attitude!• Desire to help others learn and grow• Strong ability to multi-task• Team playerYou can learn more about us and what we offer,

online at www.LNAHealthCareers.com/CareersInterested candidates should submit a resume to info@LNAHC.com or fax 603-647-2175.

Is an MPH degree in your future? The MPH program

at UNH strives to meet the needs of working health

care professionals by offering a high quality, face-to-face

classroom experience centrally located at UNH Manchester.

Please visit our website at:chhs.unh.edu/hmp/hmp-masters-public-health-program

July, August, September 2016 New Hampshire Nursing News • Page 3

President’s Message

Peggy Lambert, NHNA President

What an honor it has been to serve the nurses of New H a m p s h i r e a s N H N A President. On July 1st, 2016, I will transition from NHNA President to Past President, and Bobbie Bagley will succeed me as NHNA President. This is part of a transition plan to align our election process with NHNA’s change in By-Laws which changes the term of president from 1 to 2 years. This fall when we vote on officers for NHNA we will be voting on a candidate for a 1-year position as President Elect to be followed by a 2-year term as President. The change in term, will allow the President the time in office to be able to see initiatives through and help put effective plans in place to meet our strategic goals. That will be very beneficial as we continue to work on a number of important initiatives that are important to the nurses in the state and our organization structure.

At NHNA we continue to work to strengthen our commissions. Our goal is to provide volunteer opportunities that could be either short (a project or event) or longer (serve as a traditional member of a commission) term commitment. It is important that nurses stay involved with charting our own destiny because if we do not, others who are not nurses will.

The Office of the Governor continues to reach out to NHNA to identify nurses to serve on state commissions. Todd Gardner answered a call to action that NHNA published and was appointed to serve on the Governor’s Commission on Alcohol and Drug Abuse Prevention,

Intervention, and Treatment. Dr. Judy Joy was appointed to serve on a Governor’s Commission to study shortages in NH of healthcare workers.

Of significant importance to NHNA is shaping the structure of the Northeast Multi-State Division of ANA (NE-MSD). You will recall over the past three years ANA has supported us as we work to define what a regional collaborative would look like. The purpose of the regional collaborative is to strengthen state organizations through sharing of various functions that we might not be able to support as a single small state, while retaining our state organizational identity. At this juncture in time ANA is asking the three different MSDs to develop a long term structure that would be governed and supported by the state members involved. Currently, we have been working on defining articles of incorporation that would allow the NE-MSD to enter into contracts on behalf of all states in the NE-MSD. Concurrently being worked on are by-laws that will define the governing structure of the NE-MSD. The work on the structure is expected to take the remainder of the year.

We held a very successful student conference and our June Spot Light on Nursing. In April various specialty organizations of nurses convened for an evening of discussion that was beneficial to all who attended.

But there is so much more for us to do as nurses to improve the health of our communities.

The war on drugs has far to go, NH is continuing to see its citizens die at an alarming rate; the last statistic I am aware of is that NH will see 550 overdose deaths by the end of 2016 based on the current the death rate. Much less talked about are the debilitating co-morbid conditions associated with opioid addiction, infections

such as endocarditis, abscesses that might affect the skin or deep tissue structure or the spine. Nurses must be vocal in this fight as we cannot arrest our way out of this epidemic but need to work with the state to develop paths to recovery and mental health services that all can access no matter what an individual’s socioeconomic status. Drug courts need to be present in all of our communities not just a few.

Each year over 30,000 people die from gun related deaths in the US and another 70,000 injured (ceasefireusa.org/take-action). The BBC reported that 372 mass shootings occurred in our country in 2015. The Brady Campaign stated every day 89 people die from guns of 297 people shot in the US. They also stated that every day 7 children and teens die in the US. Gun violence continues to threaten the lives of American citizens at a rate seen by no other civilized country. Common sense gun laws do not mean that peoples’ guns will be taken from them. What they would mean is a safer America. It is frightening that we are becoming immune to the mass killings, the number of guns used against victims of domestic violence, the killings when toddlers and children find guns that have been stored improperly. I encourage you to educate yourself on the issue of gun violence because if it hasn’t affected you or someone close to you it will. If you own guns keep them in a gun safe, use trigger locks to prevent accidental shootings and vote to improve gun safety in America.

In closing, I wanted to thank you all for the honor of serving you and encourage all of you to be active in NHNA or your specialty organization. The rewards are far more than you can imagine.

Respectfully,Peggy Lambert, MS, MBA, RN, CCRN-K

NHNA Annual Meeting and Awards Banquet

October 12, 2016

Invited Keynote Speaker: Pam Cipriano, President of the American Nurses Association

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Page 4 • New Hampshire Nursing News July, August, September 2016

The Relationship Between PPI and Clostridium Difficile Infection

Kimberlee Delaney

Healthcare protocols continue to develop with the ever changing needs of today’s population including the use of prophylactic medications during acute care hospitalization. The occurrence of upper gastrointestinal disorders in healthcare populations has seen an increase in the prophylactic use of proton pump inhibitors (PPI). While PPIs provide an effective and appropriate treatment for those affected by erosive disorders of the gastrointestinal tract, the drug may not be appropriate for prophylactic use (Heidelbaugh, 2012). Ancedotal evidence suggests that the risk of clostridium difficile infection (C. Diff) may be related to PPI use.

Clostridium difficile is an aggressive infection which is both difficult to treat and causes extremely unpleasant symptoms. The most notorious symptom is the associated diarrhea caused by an inflammation of the colon (Mayo Clinic Staff, 2016). As the bacterium continues to evolve and gain strength against common antibiotics, its prevalence will continue to rise in at-risk populations. In severe enough cases, infection caused by clostridium difficile can only be treated by removing the affected portion of the colon. In 2011 alone, clostridium difficile was responsible for roughly a half a million infections; 29,000 people died within 30 days of diagnosis (CDC, 2015).

In order to identify best practice for prophylactic use of PPI’s a literature search was conducted using the search terms “proton pump inhibitors” and “clostridium.” By excluding research prior to 2014, English only, and full text, 22 abstracts were read and narrowed to 6 published articles that were applicable. The PICO question to be answered: How does the prophylactic use of proton pump inhibitors relate to the occurrence of clostridium difficile infection? Further, do the risks of prophylactic use outweigh the benefits?

Critical Appraisal of the EvidenceDeshpande and colleagues (2014) conducted a systematic review and meta-analysis including a total of 33 studies with 18,530 participants. Two investigators were chosen to search the evidence regarding risk factors for clostridium difficile; inclusion criteria included both randomized and non-randomized studies. The findings determined that the three most frequent and evidenced risk factors associated with clostridium difficile infection included advanced age, additional antimicrobial use during follow up care, and proton pump inhibitor use. It is important to note that the population was not well defined in this meta-analysis of 33 research studies. The age range, gender distribution, and comorbidities were not specifically mentioned in the data selection criteria, which could have greatly impacted patient’s susceptibility to clostridium difficile infection. The length

of hospital stay was also not explored, which would be particularly helpful in exploring the length of time clostridium difficile takes to cause symptoms and damage.

A retrospective cohort study by McDonald and others (2015) included patients of two university associated hospitals in Canada. Risk factors identified included age greater than 75, continuous proton pump inhibitor use, length of stay, and antibiotic re-exposure. Results overwhelmingly concluded that continued use of proton pump inhibitors in patients with a history of clostridium difficile infection places patients at an elevated risk for reoccurrence. Interestingly, the study also revealed that less than half (47%) of patients had an evidence-based indication for proton pump inhibitor use. However weaknesses in the study were a relatively small sample, differing length of the treatment amongst participants, and the potential for a lack of similarity between treatment protocols in Canadian and U.S. hospitals. The selection criteria for this study was not well defined and the reason for previous exposure to clostridium difficile was not mentioned. Despite the limitations the researcher ultimately suggested with confidence (CI 95%) that the use of proton pump inhibitors in patients previously exposed to CDI increases the risk for reoccurrence of infection (McDonald et al., 2015).

A retrospective chart review at a large tertiary care hospital in the United States evaluated appropriate versus inappropriate prescribing of proton pump inhibitors using the American Society of Health-System Pharmacists and nonsteroidal anti-inflammatory ulcer prophylaxis guidelines (Redfern et al., 2015). Of the 303 medical records reviewed, only 119 (39.4%) patients met the guidelines for PPIs. Patients receiving prescriptions for proton pump inhibitors post discharge were noted to be older, had higher scores on the Charlson Comorbidity Index, and had longer ICU and hospital length of stays. Ultimately, results again concluded that patients are being inappropriately prescribed proton pump inhibitors. Not only are patients being given unnecessary pharmacological therapy, but in doing so they are being placed at greater risk for serious gastrointestinal compromise.

Pappas and others (2016) aimed to determine the effects of proton pump inhibitors, and if their benefits outweighed their risks. Interestingly, the study’s design applied a microsimulation model which used literature derived estimates of the risks of C. diff infection in relation to PPI use. Participants were simulated general medical surgical patients outside of the intensive care unit. Infection risk was calculated for each simulated patient. The results of this study predicted an increased patient mortality risk in 90% of the simulated cases. As with other studies, there are some weaknesses which may have affected such drastic study results. The link between PPI use and these hospital acquired infections was assumed and other factors which could have influenced the occurrence of a C. diff infection were not explored. Arguably the greatest weakness, or potential advantage to this study, was that it was designed using a microsimulation model. Further description of how the microsimulation program works could have strengthened the argument proposed by the results of this study. A particular benefit which does strengthen the study is the fact that the microsimulation’s data is literature devised.

Croft et al. (2016) explored inappropriate gastric acid suppression preceding clostridium difficile infection. The study was conducted within the Veteran Affairs facility, a 727 inpatient bed hospital. Eligible participants were greater than 18 years of age and had either a primary, recurrent, or reinfection of C. diff. Patients were identified using clostridium difficile toxin gene polymerase chain reaction assays and chart review. Gastric acid suppressant medications prescribed within 8 weeks preceding their diagnosis of clostridium difficile infection were assessed for appropriateness of therapy using AGA guidelines. Of the 71 episodes of infection recorded during the study period, it was found that 38% were preceded by inappropriate administration of gastric

July, August, September 2016 New Hampshire Nursing News • Page 5

National Nurses Week begins every year on May 6th and

ends on May 12th, the birthday of Florence Nightingale. However,

these permanent dates were not always etched on the calendar. In 1953 a proposal was sent to then President Eisenhower to proclaim a Nurses Day in October of 1954, it was never proclaimed. Nurses still celebrated from October 11-16 the 100th anniversary of Flo’s mission to the Crimea. A bill was sponsored to commemorate Nurses Week in the 1955 Congress, but no action was taken. Nearly 20 years later a similar bill to proclaim a “National Registered Nurse Day” met a similar fate. In 1974, the International Council of Nurses proclaimed May 12 to be International Nurse Day; President Nixon followed in February of 1974 and proclaimed a National Nurse Week. The next presidential proclamation was not until 1982 when President Reagan proclaimed May 6 to be “National Recognition Day for Nurses.” In 1990, the ANA expanded the recognition of nurses to the full week, from May 6 to May 12, and in 1993 established these permanent dates. May 8 was designated by ANA as National Student Nurses Day, and Wednesday of the week is celebrated as National School Nurse Day.

Nurses Weekacid suppressant medications. For those who had been prescribed gastric acid suppressant medications prior to their diagnoses, 67% were determined to have been prescribed such treatment inappropriately. The greatest limitation to this study was that the specific gastric suppressant medications taken by participants were not clarified within the research. However, given the evidence provided by this study, the relationship of inappropriate prescribing of gastric acid suppressants to CDI was again reinforced and suggested as a possible cause of infection.

An analysis of fecal samples done both prior to and following the use of proton pump inhibitors suggests that bacterial strains are increased with PPI use. Schuyler, (2015) evaluated fecal samples prior to PPI use and again at 4 weeks, 8 weeks, and 12 weeks of PPI use. Streptococcaceae, Enterococcaceae, Micrococcaceae, and Staphylococcaceae bacterial strains following 12 weeks of proton pump inhibitor use increased. These strains are evidence of gastrointestinal bacterial overgrowth, therefore increasing the risk for CDI. Though this research study had limitations it demonstrated how proton pump inhibitors alter the microbiota composition of patients.

RecommendationsEvidence of the risks associated with prophylactic use of proton pump inhibitors is clear and well established. Though proton pump inhibitor use is important in at risk populations, it is clear that providers are over prescribing. As we emerge into the age of polypharmacy, it is important to evaluate the use of each medication that is given and assess for unnecessary medication administration. Given the uniqueness of each patient situation it is imperative that healthcare providers and nurses assess the administration of medications and their appropriateness for each patient. The evidence surrounding the negative impacts of inappropriate use of gastric suppressants overwhelming concludes that in doing so, we are putting patients at greater risk for poor outcomes and ultimately, death.

As as student nurse is not uncommon for me to hear patients questioning why they are receiving each medication they are given in the hospital. One clinical moment which particularly stands out in my mind is when a patient asked why they were being given protonix, to

which the nurse responded by saying, “It is just a common thing we do with all of our patients. It prevents stomach complications.” The evidence indicates that this response is not appropriate. It is not a standard of care to prescribe and administer gastric suppressants to every patient admitted to the hospital. In conclusion, determining which patients would benefit from prophylactic PPI administration is critical to ensure that the benefits of its use outweigh the risk or actual harm.

Kimberlee Delaney was a junior nursing student at the University of New Hampshire at the time this article was written. She lives in Moultonborough, New Hampshire.

ReferencesCDC (2015). About Clostridium Difficile. Retrieved from

http://www.cdc.gov/HAI/pdfs/cdiff/Cdiff_tagged.pdf Croft, L., Ladd, J., Doll, M., & Morgan, D. J. (2016). Inappropriate

Antibiotic Use and Gastric Acid Suppression Preceding Clostridium difficile Infection. Infection Control & Hospital Epidemiology, 37(4), 494-495 2p. doi:10.1017/ice.2016.2

Deshpande, A., Pasupuleti, V., Thota, P., Pant, C., Rolston, D. D., Hernandez, A. V., & ... Fraser, T. G. (2015). Risk Factors for Recurrent Clostridium difficile Infection: A Systematic Review and Meta-Analysis. Infection Control & Hospital Epidemiology, 36(4), 452-460 9p. doi:10.1017/ice.2014.88

Heidelbaugh, J. (2012). Overutilization of Proton Pump Inhibitors: What the Clinicians Need to Know. Therapeutic Adv Gastroenteral 5(4), 219-232. doi: 10.1177/1756283X12437358

Mayo Clinic Staff (2016). C. Difficile Infection. Retrieved from http://www.mayoclinic.org/diseases-conditions/c-difficile/basics/definition/con-20029664

McDonald, E. G., Milligan, J., Frenette, C., & Lee, T. C. (2015). Continuous Proton Pump Inhibitor Therapy and the Associated Risk of Recurrent Clostridium difficile Infection. JAMA Internal Medicine, 175(5), 784-791 8p. doi:10.1001/jamainternmed.2015.42

Pappas, M., Jolly, S., & Vijan, S. (2016). Defining Appropriate Use of Proton-Pump Inhibitors Among Medical Inpatients. JGIM: Journal Of General Internal Medicine, 31(4), 364-371 8p. doi:10.1007/s11606-015-3536-7

Redfern, R. E., Brown, M., Karhoff, K. L., & Middleton, J. L. (2015). Overuse of Acid-Suppression Therapy at an Urban Tertiary Hospital. Southern Medical Journal, 108(12), 732-738 7p. doi:10.14423/SMJ.0000000000000383

Schuyler, D. (2015). Proton Pump Inhibitors Alter Gut Microbiota Composition. Gastroenterology & Hepatology, 11(11), 739-739 1/3p.

Page 6 • New Hampshire Nursing News July, August, September 2016

In My Opinion

What’s in your bag?Susan Fetzer, PhD, RN

Editor, NH Nursing News

Educators are very aware that we learn from our students almost as much as they, hopefully, learn from us. It is less likely that a student can change our opinion on a health care issue. This past month, one did, not by anything she said, but something she did.

It is the whole naloxone (Narcan) issue. I believe, and still do, that Narcan is simply a Band-Aid approach to the opioid abuse epidemic. It is a quick fix for legislators to pass a bill to allow anyone to administer the drug. They feel like they have done something for the problem, not realizing that it is just that, a quick fix. Narcan lasts 30-90 minutes, opioids are longer lasting. After administering Narcan the patient in pain once more becomes belligerent and is transported to the local emergency department. The quick fix becomes an emergency nursing problem. The angry patient can now sign out AMA, and the cycle begins. A nurse related a situation to me that a patient was bragging that she had received Narcan on six different occasions. Where is the fix?

A junior student stayed after class one day to tell me her story; she agreed that I could share it.

“I got a call from a friend on Saturday afternoon. She asked me on the phone if I knew CPR. I thought this was a strange question as she is not one to ask for help. I asked her what was going on and she said a friend of a friend was in trouble and they did not want to call 911. I grabbed my nursing bag, and drove over to their place. When I arrived, the friend was sitting on the couch. He was not moving and was not responding. He was breathing and I checked his pulse and it was fine, though a bit high. I took out my pen light and checked his pupils and they were pinpoint. The way the others were acting, I knew there were drugs in the house. I had just taken the presentation on administering nasal Narcan, and we were given a Narcan dose after the presentation, I had put it in my bag. I took out the Narcan and gave it to him. Then I told his friends they had to call 911. They didn’t want to and told me they didn’t know what to say; but it would be OK if I called 911. I did. We moved the patient to the floor, putting him on his side as I was afraid he would aspirate if he was on his back. By the time the ambulance arrived, he had woken up, sat up, but was still slurring his words. He spoke clear enough to tell everyone that he was angry they didn’t let him die. He said dying was better than going to jail.”

My first response upon hearing the story was pride that the student had followed the nursing process-assess-plan-intervene-evaluate; all educators desire to see critical thinking applied. My second response was a realization of the student being in the right place at the right time with the right information and the right drug. The optional Narcan presentation had paid off, nearly immediately. My third response was to wonder why her friends felt the need to call a nursing student instead of 911. The answer to this question is quite obvious. Among the general public, nurses

have been ranked as the most honest and ethical profession for 14 straight years, 17 percentage points greater than any other profession. It seems that among college students, nursing students are similarly ranked. Students would rather connect with peers than others in positions of authority.

The story has changed my perspective. I have requested that all nursing students on our campus be required to attend Narcan training at the beginning of their sophomore year. What about you? It is likely that you carry a pair of surgical or clean gloves in your car, in case of an emergency. Many of us carry an Epi-pen; some have their own bag-valve mask for a just-in-case situation. It seems only appropriate for all nurses in New Hampshire to consider adding Narcan to their must-have stock of supplies.

It is still a Band-Aid. We need to work on making sure legislators know that addiction programs are sorely needed. In my opinion, if every nurse in New Hampshire carried Narcan that would be a good start to broadcast our concern and pleas for a real treatment.

Instructions for Administering Nasal Narcan1. Initiate CPR, call 911 if needed.

2. Affix the nasal atomizer (applicator) to the needleless syringe and then assemble the glass cartridge of naloxone (see diagram).

3. Tilt the head back and spray half of the naloxone up one side of the nose (1cc) and half up the other side of the nose (1cc).

4. If there is no breathing or breathing continues to be shallow, continue to perform rescue breathing for them while waiting for the naloxone to take effect.

5. If there is no change in 3-5 minutes, administer another dose of naloxone and continue to breathe for them. If the second dose of naloxone does not revive them,—either it has been too long, there are no opioids in their system, or the opioids are unusually strong and require more naloxone.

6. Continue monitoring and CPR if needed until rescue personnel arrive.

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resume or complete an application at 80 Lyme Road, Hanover, NH 03755.Kendal at Hanover is an equal opportunity employer, a drug-free workplace and a tobacco-free community.

July, August, September 2016 New Hampshire Nursing News • Page 7

This Month in Nursing History

Holly Clayton RN, MSN, ACNP-BC

The ANA Initiative to prevent CAUTI (catheter-associated urinary tract infections) offers three evidence-based approaches to improve care. The goal is to reduce the rate of CAUTI as follows: (1) prevention of inappropriate short-term catheter use, (2) nurse-driven timely removal of urinary catheters, and (3) urinary catheter care during placement (nursingworld.org).

Going back to 1876, consider what the book entitled “Lectures on Nursing” offered regarding the cleaning of urinary catheters. These lectures were delivered by William Robert Smith, Resident and Surgeon at the Royal Hants County Hospital, England (now known as Royal Hampshire County Hospital or Winchester County Hospital). The hospital opened in 1736 and Florence Nightingale was involved with the move of the hospital to higher ground in the 1860’s, due to drainage problems.

Per nursing lecturer, 1876: Catheters were to be washed with water, before using, especially smaller size catheters. After soaking the catheter in water, it was to be held up to drain it. “After this has been repeated twice, the nurse may blow through the instrument in the water, so as to make sure the eyes are clear. Now dry the catheter with a towel, again blow through it to dry the interior” (Clark, p. 66). Catheter placement was done with the patient covered and the nurse standing on the right side locating landmarks. It was noted a certain surgical patient population (ovariotomy patients) would require catheter placement and drainage every 6 hours. Another lecture in this book noted nearly every surgical patient had a postoperative wound infection.

References: ANA CAUTI Prevention Tool. Retrieved from www.

nursingworld.org

Care of Catheters: 1876

From the Bookshelf

Essential Procedures for Emergency, Urgent, and Primary Care Settings

Theresa M. Campo and Keith A. LaffertySpringer Publishing Company, Second Edition (2016) | Paperback, 490 pages

Reviewed by Alex Armitage, MS, APRN-BC, CNL

Essential Procedures for Emergency, Urgent, and Primary Care Settings is a concise and practice-oriented guide. This well illustrated clinical companion is hands-on for the busy practitioner. The format is concise, with well illustrated procedures, bullet-pointed easy to read information, pearls and pitfalls for each situation. In addition to the printed text, purchase of the book allows access to an ebook and online videos for each section which round out the text quite nicely.

The book is divided into fifteen basic units which group related procedures together. Examples of these units include sonography, airway management, incision and drainage procedures, orthopaedic injuries, and miscellaneous techniques such as lumbar punctures, as well as many more. The format is simple and straightforward starting with a basic description of the problem at hand, and patient presentation in bulleted format. Treatment for the problem is reviewed as well as contraindications to treatment. The procedure is then outlined in bulleted format with sufficient detail to allow the reader to follow through step-by-step to completion. Post-procedure considerations are described, and (once again in bulleted format) educational points, complications and practice pearls are clearly laid out for quick reference. Finally there are extensive resources listed at the end of the unit for further study should the reader so wish. The format for each procedure in the book is pleasingly standardized with meticulous detail, ensuring that all the expected information is present and accessible.

Included in this second edition, are the newest trends in sonography-guided procedures in emergent, urgent and primary care settings. It includes two new chapters completely devoted to how sonography is used to enhance the accuracy of numerous procedures, such as locating and removing a

foreign body in the eye or from soft body tissues. In addition, the second edition includes evidence-based guidelines for performing ten new procedures, new photographs, the latest guidelines and evidence-based practice, as well as links to videos of surgical procedures.

It is refreshing to see a seamless blend of talent drawn from both experienced nurse practitioners as well as emergency medicine physicians. This lends a very comfortable tone to the book. This is a solid, well thought out text, and will prove to be a valuable addition to any library. Overall, the text has a clarity and focus which enhances understanding of the topics presented. It is particularly notable for crisp reading and uncomplicated, meaningful illustrations. Kudos to the authors for presenting such a medically solid book without losing the art of nursing care or the vision of a well tended patient.

Alexandra Armitage is a Nurse Practitioner and a certified Clinical Nurse Leader, specializing in neurology and neurosurgery; bringing evidence-based practice to the bedside to improve patient care, patient outcomes and institutional viability.

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In New Hampshire• Concord • Salem • Nashua • Bedford

RN & LPNOPPORTUNITIES AVAILABLEDIRECTOR OF NURSING - NASHUA

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Apply online at www.memorialhospitalnh.orgor stop by and see for yourself!

An Equal Opportunity Employer

Granite State College / Full-Time Program Director and Faculty (Non-Tenure Track) RN-BSN Program

Granite State College (GSC) is currently seeking a Full-time faculty member to serve as the Program Director for the RN-BSN program. The program is offered in both online and blended formats to meet the needs of busy working nurses.

The Program Director of Nursing will serve as the academic leader of the program. The ideal candidate will have a strong academic background, a sound professional reputation, commitment to excellence in education and teaching and possess strong, collaborative decision-making skills. This is a 12-month full-time non-tenure-track appointment and rank will be negotiable at Lecturer or Senior Lecturer based upon academic credentials and experience. This is a benefits eligible position.

Interested applicants please go to https://jobs.usnh.edu/ and click on the Granite State College globe for full job description

The University System of New Hampshire is an Equal Opportunity/Equal Access/Affirmative Action employer. The University System is committed to creating an environment that values and supports diversity and inclusiveness across our campus communities and encourages applications from qualified individuals who will help us achieve this mission. The University System prohibits discrimination on the basis of race, color, religion, sex, age, national origin, sexual orientation, gender identity or expression, disability, veteran status, or marital status. Application by members of all underrepresented groups is encouraged. Hiring is contingent upon eligibility to work in the U.S.

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Warde Rehabilitation and Nursing Center is seeking RNs, LPNs and LNAs for FT, PT and Per Diem.

Come join our staff and experience what makes Warde special and how we make a difference in the lives of our residents. We

offer sign on bonuses up to $2,000.

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Please apply by the following: Online at www.nh-cc.orgEmail: whc.hr@nh-cc.org | Fax: 603-890-1293 or in person at

21 Searles Road, Windham, NH 03087

Page 8 • New Hampshire Nursing News July, August, September 2016

Hospice NurseSharon (Clement) Nowell, 66, of Rochester, died February 28, 2016.She graduated from New Hampshire Vocational Technical College (Great Bay CC) and practiced as a Registered Nurse at Wentworth-Douglass Hospital in Dover for more than 30 years. Her passions in nursing were pediatrics and hospice.

Geriatric NurseJovana Celestine “Joanne C. Trombley” Iorio, 78, of Keene, died March 1, 2016. In a 35 year nursing career she practiced at the Keene Manor as well as for Elliot Community Hospital and later Cheshire Medical Center. She also worked for a while at Spofford Hall in Spofford. In the later years of her career she worked locally for many of the

local nursing homes including Harborside, Westwood.

Cadet Nurse GradDorothy Miron Thorp, 88, died March 3, 2016. A cadet nurse graduate of the New England Baptist Nursing School in Boston she received her master’s degree in Health and Human Services from New England College. She practiced as a nurse at Phillips Exeter Academy for 25 years.

St. Joe’s GradKareen T. (Carelli) Hamilton, 69, passed away March 5, 2016. A 1966 graduate of St. Joseph School of Practical Nursing, she then continued studies at NH Technical Institute to complete her AS Degree. She was employed as an RN for 35 years at various hospitals, nursing homes, and also rode with Milford Ambulance as an EMT.

WDH Nurse

Mary Johnson Winchell, 92, died March 11, 2016. She attended Concord Hospital School of Nursing and the Wentworth Nursing Institute in Dover, N.H., graduating in 1945. She nursed at the Wentworth Douglass Hospital for 27 years.

Concord Hospital Nurse

Cynthia A. Wessen, 86, died March 13, 2016. She earned her nursing diploma from the Elliot Hospital School of Nursing in Manchester in 1952. She practiced at Concord Hospital from 1974 until her retirement in 1990.

Elliot Nurse

Olwen “Ollie” D. (Favor) Goumas, 78, died March 14, 2016. She obtained her nursing diploma from the Laconia School of Nursing in 1958 and until her retirement in 1998, practiced as a registered nurse with Elliot Hospital for thirty-nine years.

CMC NurseAnne M. Lamere, 84, died April 2, 2016. She obtained her nursing diploma from the Mount Saint Mary - Sacred Heart Hospital School of Nursing, in Manchester, NH in 1952. She then practiced as a registered nurse at Sacred Heart Hospital which later merged with Notre Dame Hospital and became Catholic Medical Center where she worked until her retirement.

PRH NurseBarbara (Beal) Toomire, 91, of Portsmouth passed away April 16, 2016. After obtaining her nursing diploma in 1942 from Boston Children’s Hospital, she practiced for the remainder of her career at Portsmouth Hospital. Before becoming a nurse anesthetist she worked in several

NHTI GradRobin Kenney Charnley, 60, passed away from complications of pancreatic cancer on February 16, 2016. She graduated from the Waltham Vocational School of Nursing in 1977, and earned an A.S. as a registered nurse from the New Hampshire Technical Institute in Concord in 1993. She was employed

as a RN case manager with St. Joseph Hospital in Nashua for the past four years and had previously been employed with Health Dialogue of Manchester, as well as other medical practices throughout her nursing career. Since being diagnosed with pancreatic cancer she became involved in fundraising for pancreatic cancer awareness and was determined to bring attention to this form of cancer by being a survivor as well as an educator.

Elliot Hospital Nurse

Martha Jane (Hutchins) Dollen, 79, died February 22, 2016 in Florida. Prior to her retirement she practiced at Elliot Hospital in Manchester, and the Hillsborough County Nursing Home in Goffstown.

Employee Health NurseMadeleine (Poissant) “Maddie” Hanlon, 80, of Keene passed away February 22, 2016. She obtained her nursing diploma in 1956 and practiced as an employee health nurse from 1975 to 1991 at Cheshire Medical Center.

Pedi Nurse Joyce Scofield Pleatsikas, 93, passed away February 26, 2016. After graduating from the Elliot Hospital School of Nursing in Manchester, she interned at hospitals in Gloucester and Boston MA, before returning to the Elliot Hospital as a pediatric RN. Joyce later earned her Bachelor of Science Degree from

New England College. She practiced for 4 decades as a nurse, first at Elliot Hospital and then the Bartlett Elementary School in Goffstown, prior to retirement.

The New Hampshire Nurses Association honors the memory of and acknowledges the work of deceased nurses who have graduated from New Hampshire nursing schools or who have actively practiced in New Hampshire during their career. Sharing the names and information about these nurses is one way we honor their contribution to the profession. Brief submissions are welcome.

Cheshire NurseDorothy Elizabeth “Dot” (Autio) Graham, 92, of Troy, NH, died February 3, 2016. She received her nursing diploma from the Elliot

Community Hospital (now Cheshire Medical Center) School of Nursing Keene. After gaining her nursing license, she enlisted in the United States Army and served 5 years including the Brook General Hospital in Ft. Sam, in Houston, Texas. She was discharged with Honors as a Second Lieutenant. Returning to New Hampshire she practiced as a nurse for the Troy Schools and the town, as well as at Elliot Community Hospital, and later for the Cheshire Medical Center, from where she retired in 1985, as a Nurse Supervisor, after over 35 years.

Surgical Nurse

Dorothy Gorham “Dottie” Chase, 90, of Keene, passed away, February 14, 2016. She was a 1947 diploma graduate from Massachusetts Memorial Hospital and practiced as a surgical nurse at Mary Hitchcock Hospital (DHMC).

Laconia Grad

Pauline May (Meader) Towle, 74, died February 15, 2016. She was a graduate of the Laconia School of Nursing and practiced at the Lakes Region General Hospital, retiring after 45 years of service.

In Memory of Our Colleagues

State of New Hampshire Benefit Package!Rebekah Young, Director of Nursing393 High Street, PO Box 76, (603) 989-3111 Ext. 1253Glencliff, NH 03238 Rebekah.Young@dhhs.nh.gov

Applications can be completed online at www.admin.state.nh.us/hr or you can pick one up in the Human Resource Office

Equal Opportunity Employer

Glencliff Home is seeking applications for Registered Nurses I-III Licensed Practical Nurses I-II Salary Range: $48,339.20 - $67,600.00 Salary Range: $42,952.00 - $54,600.00

To provide professional nursing care to residents within an assigned unit and provide and support medical care as directed by medical staff and pursuant to objectives and policies of the nursing department and Glencliff Home. Must possess and maintain a current license as a RN/LPN in NH. Salary and Position determined by years of experience and certifications.

• 40 hours/week – Part-time Available• ($2.00/hr 2nd shift diff.)• 1st and 2nd Shift Available• Direct Care $.50/hr

Registered NursesFull and Part Time - All Shifts

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Recent Graduates Welcome!

View Job Specifications and How to Apply:http://das.nh.gov/jobsearch/Employment.aspx

New Hampshire HospitalNH Department of Health and Human Services

36 Clinton Street Concord, NH 03301Human Resources 603-271-5855

July, August, September 2016 New Hampshire Nursing News • Page 9

departments. After retiring from that position she was made the Employee Health Nurse, and was chosen to receive the Dr. Frist Humanitarian Award. Upon retirement she volunteered at the hospital.

NHVT Grad

Susan Norcross (Hennick) Provost, 69, passed away April 14, 2016. She was a graduate of the New Hampshire Vocational and Technical College and practiced for 30 years before retiring in 2014.

St. Paul’s Nurse

Barbara (Byrne) Wood, 84, died April 18, 2016 in Florida. After obtaining her nursing diplomas she practice hospital nursing in New Hampshire, Arizona and Florida, finishing up her career at St. Paul’s school in Concord.

LPNCarol Joyce (Dupuis) Snow, 73, died April 30, 2016. She was an LPN at various nursing homes and hospitals in the Monadnock region of New Hampshire.

Concord Hospital DirectorLaura Virginia Althoff, 84, died April 27. 2016. She earned her BSN from Case Western Reserve University Florence Payne Bolton School of Nursing, Cleveland, Ohio, and Master of Science in Human Services, from New England College in Henniker. After moving to New Hampshire she practiced at Concord Hospital as the Assistant Director of Nursing and was promoted to Clinical Director. She was faculty at Concord Hospital School of Nursing prior to its closure. She also served as the State Licensing and Federal Certification Coordinator, NH Department of Public Health, Bureau of Health Facilities Administration; a Protective Services Advocate, NH Office of Long Term Care Ombudsman and was licensed as a Nursing Home Administrator, State of NH.

Great Bay Grad

Sandra Jean (Dunlap) Clough, 75, died April 30, 2016. She earned her degree in nursing from Great Bay CC and practiced for 35 years at Wentworth-Douglass Hospital in Dover.

Nurse Centenarian

Pauline (Polly) Fifield Kenick, died peacefully May 2, 2016, at the age of 106. Born in Hudson, she a graduate of the 1933 class of Exeter Hospital Training School for Nurses. Her student nursing experience is memorialized on the “Wall of History” at the present Exeter Hospital; her student uniform and memorabilia are included in the Exeter Historical Society’s collections. A lifelong career as a registered nurse ended with retirement from the Lamont Infirmary of Phillips Exeter Academy, after service at Exeter Hospital, Rockingham County Home, and the Exeter

Red Cross. As a Red Cross District Nurse, Polly taught community health classes and provided home nursing services, including home-delivery of babies! She was the holder of the Boston Post cane as Wilton’s oldest resident. She was a member of the Nurse’s Alumnae Association, serving as secretary.

WHD Grad

Katherine J. “Kay” (Hughes) Martel, 84, died May 7, 2016. She was a member of the last graduating class of the Wentworth Hospital School of Nursing in 1953. She practiced nursing for 13 years at Wentworth-Douglass Hospital and Riverside Rest Home.

Office Nurse

Jeanne E. (Levesque) Jalbert, 71, of Amherst, passed away on May 7, 2016. She attended the Concord School of Nursing and was a registered nurse throughout her career. She retired from Amherst Family Practice in 2010.

Keene NurseKathleen Patrice Garner, 67, of Keene, died May 7, 2016. She received her nursing diploma in 1969 and practiced at Cheshire Medical Center for over 40 years.

Nurses and Alphabet Soup

Graduation 2016 for many nurses and nursing students is when they add educational credentials to their signature. If you have ever obtained a certification in a specialty you have added credentials. Credentials are a part of every journal article or book chapter. The American Nurses Association recognizes that the listing of credentials helps to identify the nurse as knowledgeable and credible to consumers of nursing care. In 2009, the ANA published a position statement on “alphabet soup” credentials establishing a standard order of presentation.

In order, after your name:

1. Highest degree earned in nursing such as AD, BSN, MSN, PhD or DNP. It is not necessary to put all of your nursing degrees! This credential is permanent, you earned it, it is yours for life. If you have non-nursing degrees you may choose to list them, but place them before the nursing degree. When you obtain a higher degree in the same field of study, the lower degree is no longer used.

2. Licensure such as LPN, RN. When you retire you won’t be licensed anymore, so it comes after your education.

3. State designation which recognizes authority to practice at an advanced level such as APRN.

4. National certification recognized by a nationally recognized credentialing body such as CNOR, CCRN, CRNI, or BC. It is not appropriate to use BCLS, TNCC, IVC. Certification is voluntary.

5. Awards and honors of outstanding service or accomplishments such as FAAN (Fellow in the American Academy of Nursing)

The letters should be all capitalized, with no comma after the name, but between each designation. The designation (c) is only used for doctoral students who have completed all coursework AND been successful at a comprehensive examination of knowledge required by the degree granting institution. The (c) indicates the student is a candidate for the degree but has not yet completed a dissertation.

In Memory of Our Colleagues

Seeking RNs, LPNs and LNAsPlease apply by email to:

careers@co.rockingham.nh.usLeslie Fabian, Director of Nursing

117 North Road | Brentwood, NH 03833Visit www.co.rockingham.nh.us

Phone: 603-679-9391 | Fax: 603-679-9456

Page 10 • New Hampshire Nursing News July, August, September 2016

KUDOSCongratulations to Karen Donoghue BS, RN, of the NH Immunization Program who was awarded for Excellence in Adult Vaccination Leadership. Cindy Foley BSN, RN, of the Spaulding Youth Center, Northfield, NH and Linda Culver, RN, of Littleton Regional Hospital were awarded the Excellence in Childhood & Adolescent Immunization. The nurses were recognized for their achievements at the NH Immunization Conference in April 2016 sponsored by the Department of Health and Human Services.

Nancy Wells, MS RN NCSN was appointed to the new School Nursing Coordinator position with the New Hampshire Department of Education. Wells, a nationally certified school nurse, and Past-President of NHSNA will be providing technical support, resources and trainings to all

of New Hampshire’s school nurses, as well as monitoring the legislation that impacts school health and school nursing practice. The position is part of the Office of Student Wellness in the Bureau of Special Education.

Bobbie Bagley RN MSN has been appointed the Director of Public Health and Community Services in Nashua, New Hampshire. The New Jersey native, who has lived in New Hampshire since 1992 and Londonderry since 2002, was confirmed to the new Nashua role in February 2016.

Carol Shanahan RN was the recipient of the 2016 St. Martin de Porres Award, given annually to a professional who exemplifies the virtues of Catholic healthcare. A graduate of St. Joseph’s Hospital School of Nursing the majority of her career was focused on critical care. Recently she has worked in home care infusion services.

Eta Iota Sigma Theta Tau Chapter News

Eta Iota Inducts New Members

The Eta Iota Chapter of Sigma Theta Tau welcomed 56 new members into the organization at our induction ceremony held on April 9th. This year’s keynote speaker was Maribeth Quinn, RN, CNM, MS. In her role with Midwives for Haiti, Maribeth trains Haitian nurses to become skilled birth attendants. She shared stories of her important work with our inductees and friends and family members at the ceremony held in Hampshire Hall at the University of New Hampshire. Maribeth will be inducted as a Nurse Leader into the Chapter this fall.

Nursing professionals not previously inducted as students can join STTI as Nurse Leaders. If you have not been inducted previously, please consider applying for membership and encourage friends and colleagues who you recognize as leaders to join. Those interested in applying for membership should review the Nurse Leader Membership Criteria (http://www.nursingsociety.org/why-stti/stti-membership/apply-now/nurse-leader-membership-

criteria) and complete the printable Nurse Leader application (http://www.nursingsociety.org/docs/default-source/Members/nl_application.pdf?sfvrsn=0). Completed applications and supporting materials should be sent to Chapter President Joyce Cappiello at joyce.cappiello@unh.edu before September 15th. We will induct Nurse Leaders into the Chapter during our fall event.

On May 10, 2016 member Joan Widmer presented her research at the Ann Manchester Kelly Nursing Inquiry Day. Her study “Improving the Quality of Nasal Specimen Collection for Influenza A + B Screening” was partially funded by the chapter. Widmer will be presenting her work at a Global Conference in the fall. The Eta Iota Chapter continues to offer funding to members to present their research at conferences and other venues, and is accepting applications to support on-going research by active members. Please email Rosemary Taylor at rosemary.taylor@unh.edu for further information.

by Deborah A. Thomas, M.Ed., LPC, CADC, Chief Executive Officer

The Walker Center, Gooding, IdahoEmail: debbie@thewalkercenter.org

Reprinted with permission from the February 2016 RN Idaho

Addiction is a chronic, progressive, primary disease that if left untreated will lead to an early death. According to the American Society of Addiction Medicine [ASAM] (2011, Definition of Addiction, para 1), addiction “is characterized by an inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.”

Strategies for Nurses Encountering Patients at Risk for Addiction or Substance Use Disorder

As the first step in helping a person at risk for an addiction or with a substance use disorder (SUD), the nurse must recognize that there is an addiction problem. When encountering these adolescents and/or adults, a nurse may feel manipulated and experience an active addict’s playing on the nurse’s emotions with lies, complaints, or even appealing to the nurse’s sympathies in order to continue to obtain the reward the addict may be actively seeking. Oftentimes a nurse will not know how to interact with these patients. Even worse is that those persons at risk for addiction or with a SUD will not know what to do with themselves. It’s a frustrating situation. It can seem hopeless at times for the patient, the patient’s family, and the nurse.

How Nurses Can InterveneIn interactions with persons at risk for addiction or SUD, nurses may not know the words that will help these individuals or their family. From a nurse’s perspective, it may be challenging to determine whether a patient at risk for addiction or with SUD needs inpatient or outpatient treatment. The expectation is not that the nurse would assess or treat these patients, but instead should make a referral to an addiction treatment center. Nurses should be aware however that this might lead to upset patients and/or family members. The person at risk for addiction or with SUD needs to hear that there is hope, that there is someone that can provide options, and that life can get better.

At the addiction treatment center, the addiction specialist will conduct a multidimensional assessment of the individual using the American Society of Addiction Medicine Criteria (see Figure 1). According to ASAM (2011. ASAM Criteria, para 1), these criteria are a “comprehensive set of guidelines for placement, continued stay and transfer/discharge of patients with addiction and co-occurring conditions.”

Nurses play a pivotal role in ensuring the patient receives the best treatment. By facilitating the referral, nurses plant the seed to initiate change, which may turn around the life Figure 1. ASAM’s Six Dimensions of

Multidimensional Assessment

of these individuals and assist them toward sobriety and ultimately to become a productive, motivated contributor to society. Residential facilities such as The Walker Center in Gooding, Idaho, can help treat adults over 18 who are at risk for addiction and/or who abuse drugs and alcohol. The underlying emotional or behavioral issues are addressed through gender-specific and gender-separate treatment such as cognitive behavioral group therapy.

If you are concerned about someone who has a substance abuse problem, facilitate the addiction specialist consult.

ReferencesAmerican Society of Addiction Medicine. (2011). ASAM criteria.

Retrieved from http://www.asam.org/publications/the-asam-criteria

MAKING A DIFFERENCE

Join our team of dedicated nursing staff located in the Lakes & Three Rivers Region.

Nursing positions currently available in a variety of departments.

Come be part of an organization where you can really make a difference in the health and wellness of the community.

Please apply online at www.lrgh.org

Carroll County Mountain View Community IS HIRING!Come work in a dynamic environment that provides competitive compensation and benefits!

RN’s and LPN’s – P/T, Per Diem, all shifts

We are easy to find near the junction of RT 16 and 28 in Ossipee. Stop by for an application or visit our website at: www.carrollcountynh.net.

Please submit completed application to:Wynette DeGroot, HR DirectorPO Box 152, Ossipee, NH 03864(phone) 603-539-1721 (fax) 539-1804wdegroot@carrollcountynh.netCarroll County takes pride in being an Equal Opportunity Employer

Looking for skilled RNs and LNAs to work in the home setting. Previous experience preferred but will train the right candidate.

Psych experience and bilingual candidates a plus.

Please send resume to Diane Radziewicz, RN, Clinical Director,d.radziewicz@nhpartnership.org

Healthy at Home12 Amherst StNashua, NH 03064603-595-4243Fax (603) 880-3171

July, August, September 2016 New Hampshire Nursing News • Page 11

Ed Note: Regularly exercising our sense of humor improves resiliency, positivity and balances anti-negatively. Laughter may not solve problems but can change your chemistry allowing you to face them anew. “Humor Me”

offers quips and stories to help you see things differently. Submissions are welcome.

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~

During the course of a day, we read a lot of signs telling us where to go, what to see, what is on sale and how we should behave. These signs might say something else!

A SIGN IN A SHOE REPAIR STORE:

A SIGN IN A GYNECOLOGIST OFFICE:

A SIGN IN A PODIATRIST OFFICE:

A SIGN AT A OPTOMETRIST OFFICE:

A SIGN ON THE PLUMBER’S TRUCK:

A SIGN AT A TIRE STORE:

A SIGN ON AN ELECTRICIAN’S TRUCK:

A SIGN IN A NON-SMOKING AREA:

A SIGN ON THE MATERNITY ROOM DOOR:

A SIGN AT A CAR DEALERSHIP:

A SIGN AT THE MUFFLER SHOP:

A SIGN AT THE VETERINARIAN’S OFFICE:

A SIGN AT THE ELECTRIC COMPANY:

A SIGN IN THE WINDOW AT THE LOCAL DINER:

A SIGN IN THE FRONT YARD OF A FUNERAL HOME:

Dr. Jones, at your cervix.

Time wounds all heels.

Let us remove your shorts.

No appointment necessary. We hear you coming.

We repair what your husband fixed.

Invite us to your next blowout.

If you don’t see what you’re looking for,You’ve come to the right place.

If we see smoke, we will assume you are on fire and will take appropriate action.

The best way to get back on your feet – miss a car payment.

Don’t stand there and be hungry; come on in and get fed up.

We would be delighted if you send in your payment on time. However, if you don’t, YOU will be de-lighted.

Push. Push. Push.

Be back in 5 minutes. Sit! Stay!

Drive carefully. We’ll wait.

We will heel youWe will save your sole

We will even dye for you.

Humor Me Welcome New and Returning NHNA Members

Thanks for Your Support of Nursing in New Hampshire!

NHNA welcomes these new and returning members. If you are not a member ask someone on this list why they joined! Go to nhnurses.org where joining is easy and one of the best professional values for your money!

We want to see your name here in the next issue of the NH Nursing NEWS!

Penedum Adumene ManchesterLindsay Andronaco MilfordCynthia Arcieri HollisEva Barger ManchesterNathalie Beaudoin ManchesterLisa Bedard NashuaLaurie Bergeron SalemCatherine Bernard ManchesterDeann Berthiaume MilfordMelinda Bicknell AndoverArianah Blanchard BenningtonTara Bolduc GraftonLauren Boulton PittsfieldChelsea Brennan HennikerMelissa Canarelli HudsonPeter Chemei FarmingtonAngela Clark WebsterSharon Coronado HudsonJacklyn Crosby GlencliffCasee Cullen LondonderryShauna Dalleva NashuaKaitlynn Daneau LondonderryJudith Darnell-Brozovic ManchesterDana Deboard ChesterHillary Deguire HanoverThandiwe Dhliwayo GoffstownLynda Doherty ConcordDeirdre Donovan North SwanzeyAmy Eilertsen HanoverAnn Elder AuburnJeannie England BristolColleen Falardeau LitchfieldMelissa Fernandez ManchesterSharon Fredette AmherstSusan Frieda HudsonMegan Gauvin CanaanMaureen Gaynor GranthamAnn Marie Gelsomini NewtonEmily Glaner West LebanonDonna Grant DeeringLaura Harwood SeabrookToria Haungs HoldernessSheila Howley Litchfield

Ellen Hubbell LebanonTammy Hynds PenacookKathryn Ippolito GranthamKimberly Jacobson HudsonJ. Dean Jarvis GranthamMarawiya Julkiply LebanonHolley Kazakis HamptonJoanne Kelly MarlowJennifer Knights LondonderryElizabeth Kotrady LebanonCarol Krasin AmherstKatherine Krawczyk ManchesterDebra Krison-Dowd HamptonChelsea Laughton DoverJoseph Lavallee ManchesterMelissa Lopez ManchesterMary Matthews ConcordRobin Mose HancockBrittany Nyman New BostonKaren Parr-Day WarnerKelsey Pearl NewfieldsAmanda Porter RollinsfordJulia Puglisi ManchesterCynthia Quigley MilfordJennifer Roy ManchesterAmanda Sargent DerryPatricia Scala SalemJessica Schwartz ManchesterCynthia Smiddy MerrimackHeather Smith ConcordJulia Sterner̀ LeeTimothy Tarner EnfieldKelley Taylor RochesterFrances Todd North HaverhillCynthia Tubman-Woodman HanoverFelicia Uzuyem PelhamPenny Van Alstyne KeeneKaren Van Houten JaffreyConstance Vincent West ChesterfieldLeila Volinsky HamptonDiane Walker ManchesterCourtney White Portsmouth

RN ManagerIN THE LYME, NH AREA

Work as part of our team, providing care for up to 12 individuals at our Total Care and TBI residence.

The RN Manager conducts nursing assessments and care plans, serves as liaison with health care practitioners, and

ensures a safe medical environment for consumers and staff. Degreed and NH-licensed RN with supervisory and leadership

experience and professional level communications skills essential. Must have 2 years licensed nursing experience within

the last five years, with at least one year as an RN.

$1,000 Hiring Bonus*previous employees are not eligible for bonus.

Applications are found on line at www.pathwaysnh.org orsend resume to khenning@pathwaysnh.org.

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We are dedicated to expanding opportunities that enrich the lives of people with disabilities, and our services are provided in

a spirit of partnership and respect.

An Equal Opportunity Employer

Page 12 • New Hampshire Nursing News July, August, September 2016

School News

Southern New Hampshire University

celebrated Nurses Week with students and

nurses when Bonnie Fecowicz, a full-time

working nurse and student in SNHU’s online

Master of Science in Nursing program,

pulled on a purple latex glove and took to the

field to throw out the ceremonial first pitch

at the Fisher’ Cats May 9, 2016 ball game.

River Valley Community College was

granted full initial 5 year accreditation

by the Board of Nursing during the

February 2016 meeting.

Rivier University is accepting applications for September enrollment for an online DNP program. The program requires 39 credits and is expected to take 2 ½ years. One on-campus day per session is required.

New Hampshire Technical Institute in Concord received continued 8 year accreditation by the Board of Nursing during the February 2016 meeting.

Saturday, April 23 was a

memorable day for the 67 senior

nursing majors who received their

Saint Anselm College nurse’s

pin in a ceremony at the Abbey

Church. Commencement exercises

were held on the lawn in front of

Alumni Hall May 21, 2016.

The Doctor of Nursing Practice Program at UNH has been moved to an online program with 8 weeks courses as of Spring, 2016.

ED Note: News from nursing schools, faculty, students or alumni are welcome. Please direct submissions to office@nhnurses.org

with NHNN in the subject line.

BSN Programs on ProbationTwo nursing programs were placed on probationary status during the February meeting of the New Hampshire Board of Nursing. The programs had received conditional status by the BON up until February. Plymouth State College director Dr. Kathleen Patenaude and Keene State College director Dr. Thomas Connelly were informed that they had 12 months, according to the Board of Nursing, to make changes to improve the first time NCLEX pass results of their graduates. Yearly pass rates at Plymouth State since 2013 were 72%, 65% and 56%; pass rates at Keene State since 2013 were 78%, 48% and 62%. In contrast the rates for all New Hampshire programs were 83%, 86% and 87% which exceeded the national average each year. During probation, the nursing programs have 12 months to identify deficiencies, write a plan to correct them and enact changes to meet the standards for full approval, according to the BON Rules and the NH Nurse Practice Act.

The Board of Nursing included specific requirements under the probationary status. The specific requirements included limiting incoming class size and curriculum revisions. In March, the Senate of Keene State College which oversees policymaking, voted to change the curriculum proposed by the nursing department, upping its standards. One of the major changes is the beginning of nursing courses in the fall of the junior year. All 4 year New Hampshire BSN programs including Colby-Sawyer, St. Anselm and UNH begin nursing courses in the freshman or

sophomore year. Plymouth State has also adjusted their curriculum with nursing courses beginning in the first semester of the sophomore year. With changes taking place in the fall, freshmen and incoming Keene State students will take the entire new curriculum, while current sophomores and juniors will see a modified version. Because some sophomore nursing students will get caught in the middle, Keene State is looking to offer online courses over the summer with free tuition.

Keene State also increased academic standards for nursing students. Students were required to maintain a 3.0 overall GPA, as well as a 3.0 GPA in science classes, according to Keene State’s nursing student handbook. The new requirements are a 3.4 overall GPA and a 3.25 GPA in science classes. According to the Plymouth State web site, a minimum GPA of 2.67 is required.

The Board of Nursing also restricted class size at Keene to 32 students. Currently there are 57 sophomores and 43 freshmen. Keene State officially

admits students to the major at the end of the sophomore year.

Board of Nursing requirements included offering nursing students additional resources to improve their performances academically and on the NCLEX-RN. In response, Keene State’s actions include the hiring of a lab coordinator to host open lab hours to allow students to practice their skills, and providing two NCLEX tutors at no additional cost to students

Both programs began in 2012 with 3 years to obtain full approval by the Board of Nursing. During this time the Board provides conditional approval. When the three year period is up and full approval is not met, programs are placed on probation. The Board of Nursing can extend the probationary period by six months if a program shows its efforts at compliance demonstrate good faith and its plan of action is realistic and complete, according to the rules. If not, the nursing program faces the withdrawal of its status by the state nursing board and closure of the program.

NH Nursing By the Numbers

–Source: American Association of Colleges of Nursing

709: NCLEX Applications for NH License in 2015

87: Percent pass rate for NCLEX in 2015

1,741: APRNs in New Hampshire

112: Nurse Midwives

342: Certified Nurse Anesthetists

26,000: Licensed nurses

52: Average age of NH nursing faculty

RN Supervisor Clinical Lead

Lamprey Health Care, one of NH’s oldest Community Health Centers, is currently looking for a full time RN Clini-cal Lead to be part of our dynamic management team.The primary role of this position is to oversee the supervi-sion of the Medical Assistants as well as working with our providers and interdisciplinary staff on the floor to care directly for our patients, which includes a diverse popula-tion. We are looking for someone that has strong clini-cal and assessment skills, is organized, and is a proven hands-on leader that enjoys helping people while making a difference with our vision, which supports the Patient Centered Medical Home model.

This role also participates in office based nursing, triage, community outreach and follows standard evidenced based protocols and policies. RN license is required. Min of 2 years of recent experience in an office setting or acute care environment is strongly preferred. Bilingual in English/Spanish also preferred. Previous supervisory experience is also preferred. Patient Care and Equal Op-portunity Employer.

Interested applicants may apply online at: http://www.lampreyhealth.org/Phone: 603.292.7777

July, August, September 2016 New Hampshire Nursing News • Page 13

The University of New Hampshire Department of Nursing celebrated 50 years of nursing education excellence in grand style with a gala dinner-dancing alumni event held April 29, 2016 at the Grappone Center. Alums from the first graduating class of 1969 to 2015 were treated to an evening of celebration. The UNH program admitted the first class of 13 students in the Fall of 1965 under the Chair of Louise Fernald. Five of the eleven first graduates still living of the class of 1969 were in attendance. Three past nursing department chair persons, including Anne Kelley, Karen and Raelene Shippee Rice were also present in addition to former and current faculty. Professor Emeritus Anne Kelley was recognized with a standing ovation as being a member of the original faculty in 1969. Alums from each decade were recognized, as well as graduates of the undergraduate, RN to BSN, graduate and DNP programs. Patti Pucilli was noted as the only three-time graduate of UNH, an alum of the RN to BSN, MSN and DNP programs.

UNH Celebrates

UNH Nursing Chairs: (L-R) Front: Anne Kelley, Raelene Shippee-Rice;

Back: Gene Harkless, Karen Johnson Recent UNH Grads reunite

Enjoying the celebration

NCLEX Reconsidered

Ed Note: If it has been a year or years since you took the NCLEX (AKA “Boards”), how well would you do now?

1. A patient is seen in the outpatient clinic and the provider suspects lupus (SLE). What diagnostic tests do you anticipate to be ordered?a. Metabolic panel and LFTsb. CBC and ANA titerc. Cr/BUN and serum

amylased. Chest Xray and Mantoux

2. A patient is seen for a follow-up office visit following surgery to remove a suspicious breast lump. The pathologist reports the tissue stage as T1, N3 and M1. This stage indicates:a. a large tumor, confined to the breast tissueb. a small tumor with cells also found in a single nodec. three small tumors found in one breastd. breast cancer that has metastasized

3. What effect does a tetanus booster provide?a. Active immunityb. Passive immunityc. Cell-mediated immunityd. IgE immunity

4. Gas tamponade was used to flatten the retina of a patient during retinal detachment surgery. Postoperatively, what action should you implement first?a. check pupil responses in both eyesb. confirm the patient is in the ordered positionc. medicate for a dull headached. obtain vital signs

5. A patient with suspected RLL pneumonia arrives in the ED and presents with the following arterial blood gas: pH 7.28, PaCO2 of 74, HCO3 of 28 mEq/L, and PO2 of 45, which of the following is an appropriate nursing intervention? (Select all that apply)a. Administer morphine sulfate 2 mg IV for

restlessnessb. Place the patient in a left lateral position to

increase drainagec. Assist the patient to breathe slowly into a paper bagd. Place the patient in a high-Fowler’s positione. Apply non-rebreather oxygen mask at 10 L

Answers on page 16

Page 14 • New Hampshire Nursing News July, August, September 2016

Student Nurse Conference 2016“Creating Your Nursing Futures 2016”

Holly Clayton RN, MSN, ACNP-BCChair, NHNA Commission on Nursing Practice

Many members of the graduating nursing class of 2016 were in attendance at the recent NHNA Student Nurse Conference, held on March 11th, 2016. This annual event was well attended, with 165 participants including student nurses, faculty members and members of the NHNA board. Students from schools across the state of NH travelled to the campus of Southern NH University (SNHU), who sponsored the conference, supplying the venue and meals for the attendees.

NHNA President’s Welcome AddressFollowing a continental breakfast, NHNA President Peggy Lambert, RN, MS, MBA, CCRN welcomed the attendees and introduced SNHU’s Provost Dr. Patricia Lynotte, who represented the university and offered a welcome and remarks. SNHU’s Executive Director for Nursing and Professions Dr. Sherrie Palmieri was a member of the planning committee for the conference.

This year’s theme of “Creating Your Nursing Futures 2016” provided a wealth of information for nursing students, as they start to create their own nursing futures.

Special GuestsSpecial visitors at this conference included U.S. Representative, the Honorable Frank Guinta, and a very good friend of nursing in the State, the Honorable Senator Lou D’Allessandro. Both of these special guests addressed the students, expressing how much they value the work of nursing.

Awards CeremonyEach year, a student nurse is selected by the NHNA Commission on Nursing Practice to receive the Student Nurse of the Year Award at this event. The recipient of this year’s prestigious award was Dana Mott, a junior student in the Rivier University Nursing Program. Her nursing instructor Diane Droutman, PhD(c), MSN, RN, CNE was present for the conferring of the award.

Two other accomplished graduating nursing students were honored by the Commission on Nursing Practice with certificates: Beth Ann Westgate, senior nursing student at Saint Anselm College and Paige Kennedy, senior nursing student at Colby-Sawyer College.

Educational Sessions OfferedA variety of educational sessions were offered throughout the day. Students enjoyed a panel discussion entitled “How to Survive Your First Year – New Grad Wisdom.” Another panel provided information on the various career paths available to nurses. Breakout sessions addressed such timely subjects as getting the job you want and managing shift work. This event offered valuable tips and networking opportunities to help students transition from school to the workplace. Participants visited the exhibitor tables during breaks.

Presentations included:• HotTopicDiscussion:“HowtoGet theJobYouWant”byPeggyLambert,RN,MS,

MBA, CCRN• “MakingYourFuturewithPharmacologyBright”byJohnFoley,Pharm.D.• “CreatingMomentsforSelfCare”byAnnFournier,PhD(c),RN,MS,MSN,ACNP-

BC, AHN-BC, CNE • “ShiftsHappen”bySusanFetzer,PhD,RN• “ScopeofPracticeandDelegation”byDeniseNies,MSN,RN,BC,ExecutiveDirector

NH Board of Nursing

Closing RemarksThe day ended with parting thoughts from NHNA President Lambert and newly appointed Interim Executive Director Dr. Judith Joy. A raffle followed, where prizes were provided by the NHNA Board of Directors. Students then parted, and headed off into their bright nursing futures, having learned many valuable strategies for success and gained new knowledge.

Well Received The success of the event was reflected in feedback from the participants. Students from Great Bay Community College were overheard saying “what an awesome session.” A student said, “I loved hearing from the new grads.” Another student commented, “I am so impressed that [Representative Guinta and Senator D’Allessandro] came. They really seem interested in nursing.”

Sincere ThanksNHNA extends their appreciation to all of the session presenters who shared their time and expertise in making the conference such a success! NHNA again wishes to thank our sponsor and host, SNHU, who provided the venue, meals and overall support.

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July, August, September 2016 New Hampshire Nursing News • Page 15

Dear Editor,

I wish to respond to two items in the column “NCLEX Reconsidered” in NHNursing News, April 2016. The column begins with “Ed. Note: If it has been a year or years since you took the NCLEX (AKA “Boards”), how well would you do now?” The questions I wish to discuss are #3 and #5. In my opinion, Question #3 should have included notifying the provider of serum potassium = 3.3, as this value falls below the normal range and is defined as hypokalemia.

Question #5 asks the nurse to determine which patient would require his/her immediate attention and additional assessment. We are given four choices, each patient having an abnormal vital sign and a diagnosis. The answer printed was: The patient with COPD and a respiratory rate of 24/minutes required immediate attention and assessment.

I would like to thank the editor for the opportunity to consider this “triage” situation further, with consideration for critical thinking. With the information given, a single diagnosis, we are not provided with the admitting diagnosis and comorbidities, so we anticipate that each of the patients may have more complexity leading to their hospital admission. In my opinion, the absence of admission diagnosis, assessment information, clinical history, vital signs trends, labs and other pertinent data makes it difficult to truly “triage” these patients. If one thinks of “ABC’s,” the patient with COPD and elevated respiratory rate might be most at risk. However, tachycardia could actually be atrial fibrillation, and tachycardia or bradycardia can be symptomatic. The blood pressure trend is not provided. As well, Question #5 did not include the nurse requesting any additional resources for assessing the other patients. The nurse could request help from the charge nurse or colleagues as resources, to assess the other patients, while she went in to see the patient with COPD first.

Such questions are being thought about on a global level. An abstract from the International Nursing 25th International Nursing Research Congress in 2014, hosted by Sigma Theta Tau International, was entitled “More Than Vital Signs: Reframing Nurses’ Recognition and Response to Clinical Deterioration.” The abstract discusses early signs of clinical deterioration and the need for nurses’ timely recognition of these and provision of the necessary assessment to ensure optimal patient outcomes. These are the challenges facing nurses in today’s complex patient care environments. Once again, I wish to thank our insightful editor for providing the opportunity to discuss these current issues in nursing.

Sincerely,

Holly Clayton, RN, MSN, ACNP-BC

References:Cohn, J., Kowey, P., Whelton, P. & Prisant, M. (2000). New

Guidelines for Potassium Replacement in Clinical Practice - A Contemporary Review by the National Council on Potassium in Clinical Practice. Archives of Internal Medicine, 160 (16), 2429-36.

doi:10.1001/archinte.160.16.2429.Osborne, S. (2014), More Than Vital Signs: Reframing

nurses’ Recognition and Response to Clinical Deterioration. 25th International Nursing Research Congress. Wanchai, Hong Kong.

http://hdl.handle.net/10755/335692

Dear Editor,

I had some concerns reading the short article and sample questions of the new NCLEX exams. (NH Nursing News April 2016). I had concerns about some of the answers that were given and wondered what the examiner’s intent was. The answers given to question #3, about the hemodialysis patient, and #5 about the decision making process based on vital signs did not seem right. Are these questions truly representative of the exam questions? Or are they samples written by someone else? Is the intent of the examiner to help more people pass? Or to test critical thinking in nurses?

In question #3, all the nursing actions one would employ in taking care of a post dialysis patient are listed as possible choices. The question asks which nursing actions would be carried out. Well, all of them really but if the intent of the question is “which ones are the most important?” the answer given (choices A and D, monitor BP and get a dry weight) leaves out one of the more important things I would have done. Choice B reads ‘notify provider of potassium level 3.3” A potassium of 3.3 is a critical lab value and as such needs to be reported ASAP. Why wasn’t this included in the answer? Yes, you would monitor the blood pressure and get a dry weight but you would also call the provider and notify him (or her) of the labs. Are we assuming the lab has already done so? Your question doesn’t say anything about which you would do first. I would have gotten a blood pressure, gotten the weight and then called the provider with all 3 pieces of info.

In Question #5 the examiner is asking the nurse to base a triage decision on abnormal vital signs and a diagnosis. Which patient should she see first? The whole picture is not given. The info provided is the age of the patient, the diagnosis and one vital sign that falls out of normal parameters. I say in order to promote critical thinking the nurse needs more information. Wouldn’t the first step be to get a little more? Being a triage nurse I get as much information as I can before making a disposition recommendation. I would do the same thing in the hospital. Perhaps get an O2 sat on the COPD patient? Check shift report to see if the patient with the heart rate of 52 had any cardiac disease? Or determine the reason for hospitalizing the person with the Grave’s disease? How about checking blood pressure trends on the person with the adrenal tumor? If you were rushing in to see the COPD patient with the respiratory rate of 24 and got tied up in there, one of the others might get in to trouble. As nurses, we have to think outside the box. I think my first step would have been to get a little more information, as quickly as I could, and then determine who I should visit first on my assessment rounds. I would probably check on the COPD patient first, since a respiratory problem will get you into trouble more quickly than any of the others. But, if he were stable and one of the others was not, my decision would change.

I don’t know if this is nitpicking, but I have taken a few of these types of tests now and it often seems to me there is no right answer. I applaud the NCLEX writers for encouraging critical thinking but I believe in order to do that, a nurse needs to know that in practice, she must have all the information she get can get in a short amount of time, and not only make decisions about her own actions but see to whom she could delegate tasks if needed. I thought it might be helpful for people reading this article to think about these things.

Thanks so much for your time

MaryEllen King, BSN, RN, CPN

Question 3 A patient admitted for a peripheral vascular disease of the left foot has just returned from a 4 hour dialysis treatment. What actions by the nurse are appropriate? (Select all that apply)

a. Monitor blood pressure b. Notify provider of potassium of 3.3c. NPO for 4 hours after completion of treatmentd. Instruct LNA to obtain dry weighte. Maintain bed rest for 4 hours after treatment

Question 5 You are assigned the following patients to care for during your shift. The LNA reports the patients’ vital signs. Which would require your immediate attention and additional assessment?

a. A 58 yo with hypothyroidism and regular heart rate of 52 bpm.

b. A 38 yo patient with Graves disease and heart rate of 112 bpm.

c. A 63 yo patient with r/o adrenal tumor and blood pressure of 140/100.

d. A 49 yo patient with end stage COPD and respiratory rate of 24.

Ed Response:

Thank you for enjoying our NCLEX review feature. The questions are NOT obtained from the NCLEX exam as such questions are not released by the National State Boards of Nursing. NCLEX type questions are published in many books and by many vendors of NCLEX review programs. Best practices in preparing NCLEX questions are provided during faculty development programs and are developed to measure basic competencies of beginning practitioners. Information provided in the question should be the only information that is considered when answering the question.

In Question 3, an inpatient is returning to the medical-surgical floor from a dialysis unit. The student is taught that dialysis nurses monitor post-dialysis lab values and that for some patients hypokalemia may occur. In a post-dialysis patient, it is unlikely that a serum potassium level of 3.3 would treated. Symptoms of hypokalemia can be reflected in the blood pressure. The effects of dialysis, including hypovolemia, would be monitored by blood pressure (a) and obtaining a post-dialysis or dry weight (d). There are no requirements for NPO or bed rest related to a dialysis treatment. The reference provide is a good review of potassium replacement for non-dialysis patients.

The answer to Question 5 was printed in error and should be Answer C. In Question 5 the scenarios asks the student to relate the findings of a diagnosis which are expected or not-expected. Bradycardia is a frequent and expected finding in a patient with hypothyroidism (a). Likewise in a patient with Graves disease (hyperthyroidism), the heart rate is elevated (b). A patient with end stage COPD is likely to be tachypneic (d). However, in a patient in which an adrenal tumor is expected, a blood pressure of 140/100 may be a precursor to a hypertensive crisis and requires further assessment (c).

Page 16 • New Hampshire Nursing News July, August, September 2016

If You See Something, Say SomethingJennifer Flynn, BA

Manager, Healthcare Risk ManagementNurses Service Organization (NSO)

On a busy day with short staff and high-acuity patients, a nurse fails to notify the physician of an abnormal clotting time for her patient. Not knowing the result, the physician orders the patient’s heparin to be restarted. The nurse mistakenly overlooks the abnormal lab tests and implements the order. Subsequently, the patient suffers significant brain hemorrhage and permanent disability.

In this situation, you might think it was the physician’s, not the nurse’s, responsibility to check the clotting time before restarting the heparin. But in a similar case, a nurse was held liable for failing to notify the physician. The case illustrates the important responsibility of nurses to notify others of a significant change in a patient’s condition, including results of lab tests. Failure to do so can leave you open to legal action by patients or families. Here is what you need to know to ensure you are following correct procedures for notification.

A common problem Allegations related to patient assessment monitoring, treatment, and care—three main areas where notification plays an important role—are relatively common and can be quite costly, according to the CNA/NSO claim study Understanding Nurse Liability, 2006–2010: A Three-part Approach. From January 2006 through December 2010, assessment allegations accounted for 12.6 percent of closed claims with a paid indemnity greater than $10,000, monitoring accounted for 6.8 percent, and treatment and care accounted for 58.5 percent. The average paid indemnity was $228,737 for assessment, $223,282 for monitoring, and $156,857 for treatment and care. So how can you lower your risks for being named in a lawsuit as a result of not notifying practitioners?

Monitor the patient It seems self-evident that you should monitor your patients, but claim studies show that this doesn’t always happen. Base your monitoring on practitioner orders and your professional judgment. For example, if your patient is having neurologic checks every 2 hours and develops altered cognition, perform a complete neurologic assessment.

Common areas to assess include vital signs, blood glucose, lab and diagnostic test results, clinical signs of bleeding, effectiveness of pain management, signs of infection or inflammation, nutritional intake, oral and I.V. fluid intake and output, outputs (e.g., urine, stool, wound drainage), wound status, behaviors, cognition,

patient concerns, response to treatment, and patient safety.

Make the patient your ally. Tell him or her to report any problem promptly. Keeping patients and families informed will make it more likely they will speak up promptly. If there is a change in your patient’s condition, you’ll need to communicate it quickly.

Communicate effectively Think before you speak with the practitioner so you can provide the information in a way that will get results. A commonly used tool is SBAR, which staff at Kaiser Permanente created based on a tool from the U.S. Navy. Here is an example adapted from material from Kaiser: • Situation. Give a concise statement of the problem.

“Dr. Jones, I’m calling about Jack Wilson, a 55-year-old man who is pale, diaphoretic, and complaining of chest pressure.”

• Background. Give pertinent, but brief, information related to the situation. “He has a history of hypertension and was admitted yesterday for GI bleeding. He received two units of RBCs yesterday, and his hematocrit 2 hours ago was 32. His blood pressure is 90/50 and pulse 120.”

• Assessment. Provide what you found and what you think about the situation. “I think he is bleeding again, and we can’t rule out an MI, but we don’t have a recent H&H or troponin.”

• Recommendation. Request or recommend an action. “I’d like to get an ECG and labs, and have you evaluate him right away.”

To make your communication more effective, use the practitioner’s name to get his or her attention and state the problem clearly and concisely. If you are talking in person, make eye contact. Minimize background noise, particularly when you are on the phone, and avoid multitasking. Some hospitals have Rapid Response Teams that you can call if you feel the situation warrants more immediate attention. Use them if you need them.

Overcoming resistance What if you feel the practitioner isn’t listening to you or doesn’t plan to take appropriate action? According to TeamSTEPPS, a tool for enhancing patient safety that you can obtain at no cost from the Agency for Healthcare Research and Quality, it’s your responsibility to assertively voice your concern at least two times to ensure it has been heard. If the outcome is still not acceptable, you’ll need to contact your supervisor or go up the practitioner’s chain of command.

Remember that your goal is not just to notify someone—you want to ensure proper action is taken. Following the chain of command is important from a liability perspective, too. According to the Understanding Nurse Liability claims study, claims involving the failure to invoke the chain of command represented 5.6 percent of the treatment and care closed claims and had one of the highest average paid indemnities ($350,558).

Don’t forget to document It’s easy to forget to document your efforts to contact the practitioner, particularly if the patient’s condition

is declining rapidly. However, that documentation is what will protect you should a claim occur. Date and time each entry and include detailed information about the patient’s condition based on your assessment, who you notified, and actions taken. If you need to follow up with someone higher in the chain of command, note that as well. Other areas to document include reporting abnormal lab values and diagnostic tests.

Remember documentation basics: Follow your organization’s protocols and guidelines from your professional association. Don’t alter the medical record and comply with the policy for correcting errors.

Notifying practitioners These actions will help ensure you properly notify practitioner of a change in a patient’s condition: • Frequently monitor the clinical situation of your

patients so you detect problems early. Follow practitioner orders, but also use your judgment about when to conduct additional assessments.

• Listen towhat thepatient says. It canbe temptingto dismiss another complaint from a “difficult” patient. Don’t.

• Assessanddocument,ataminimum,thefollowingwhen there is a change in the patient’s condition: presenting problem(s), comorbidities affecting the patient’s status, mobility status, medications, behaviors, cognition, vital signs, and lab values.

• Notifyappropriatepractitionersofyourassessmentresults.

• Document the results of specific patient-monitoring activities according to the practitioner’s orders and as indicated by the patient’s condition, including vital signs and other relevant information.

• Document all patient treatment and care,including timely implementation of practitioner orders, patient/family education, supervision of nonprofessional caregivers, tracking of test results/consultation reports, follow-up of delays and issues in obtaining tests or test results, and reporting of any patient incident (injury or adverse outcome and subsequent treatment/response).

• Document the actions you took to notify thepractitioner and the response.

• If you do not receive a response in a reasonabletime frame, seek assistance elsewhere and document your actions.

The bottom line As a nurse, you are responsible to promptly notify practitioners of a change in a patient’s condition. The bottom line is that if you see something, say something—and document it.

RESOURCES Agency for Healthcare Research and Quality. Pocket Guide:

TeamSTEPPS. Publication number #06-0020-2. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/essentials/pocketguide.html.

CNA, NSO. Understanding Nurse Liability, 2006-2010: A Three-part Approach. www.nso.com/nurseclaimreport2011.

Kaiser Permanente. SBAR toolkit. http://www.ihi.org/resources/Pages/ Tools/SBARToolkit.aspx.

This risk management information was provided by Nurses Service Organization (NSO), the nation’s largest provider of nurses’ professional liability insurance coverage for over 650,000 nurses since 1976. The individual professional liability insurance policy is administered through NSO and underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to service@nso.com or call 1-800-247-1500. www.nso.com.

Answers to NCLEX Reconsidered from page 13

1. B2. D3. B4. B5. D, E

100 Saint Anselm DriveManchester, NH 03102

(603) 641-7086www.anselm.edu/cne

Committed to Promoting Excellencein the Practice of Nursing

Online programs now available.

12th Annual Wound Healing Symposiumby Wentworth-Douglass Hospital Wound Healing Institute

At Wentworth-Douglass Hospital Garrison Conference Center789 Central Avenue, Dover, NH 03820

November 10, 2016$ 150- Pending contact hours (7)

Register before October 14, 2016 - fee discounted to $125Speakers this year are:

• Stephen Gemmett, M.D. • Mary Liz Bilodeau, MS, ACNP-BC • Joyce Black, PhD, CWCN, FAAN • Vicki Haugen, RN, MPH, CWOCN

• Heather Hetterick, PT, PhD, CWS, CLWTFor more information or questions, please email:

Heather Sevigny, APRN, CWS at Heather.Sevigny@wdhospital.comor Stephanie Estrada, APRN, CWCN

at Stephanie.Estrada@wdhospital.com

SAVE THE DATE!

July, August, September 2016 New Hampshire Nursing News • Page 17

Kevin Walsh was appointed by Governor Maggie Hassan as a public member to the Board of Nursing. Walsh has been in law enforcement for the past 19 years and serves as the Chief of Police for Rye, New Hampshire.

The Practice and Education Committee of the Board of Nursing has responded to the following practice questions.

Question: Is it within scope of LPN/RN to do a skin scraping for scabies? Response: With the appropriate training and competency it is within a RNs scope of practice.

Question: Can a RN monitor and titrate ketamine infusions under a sedation protocol to manage chronic pain patients?Response: Yes, it is within the scope of practice of an RN to monitor and titrate Ketamine infusions in critical care settings for those clients who have a secured airway.

Question: Can lidocaine, sodium bicarb, and 0.9% NaCL solution intradermal and/orsubcutaneously be administered by RNs for minor excision procedures, in an office setting. Response: Yes, it is within the scope of the RN with education and competency.

NEWS

NHNA Commission on Nursing PracticeHolly Clayton RN, MSN, ACNP-BC

Healthy Work Environments Presentation at Monthly MeetingOn the evening of Thursday, April 14, 2016, the NHNA Commission on Nursing Practice (CNP) held its monthly meeting at MCPHS University in Manchester, NH. The first part of the evening featured a guest speaker, Meghan Baston, MSN, RN-BC, Director of Behavioral Health Services, at nearby Elliot Hospital. Her power point presentation, which included handouts, was entitled “How to Promote Healthy Work Environments.” Judith Joy, PhD, RN, NHNA Interim Nurse Executive Director attended, and nursing students were invited. This timely topic was selected by the NHNA Commission on Nursing Practice (CNP), as it strives to recognize and evaluate issues that affect nurses and nursing. Promoting healthy work environments, in which nurses can provide safe care, is in alignment with ANAs 2016 campaign for creating a “Culture of Safety” throughout health care.

Evidence-Based PracticeThe CNP seeks to promote evidence-based practice through education and dissemination of information. What does the evidence show? The Journal of Patient Safety published a study entitled, “A new, evidence-based estimate of patient harms associated with hospital care” (James, 2013). The findings revealed that our healthcare system is not error-free, as 210,000 to more than 400,000 deaths of hospital patients occur each year related to preventable harm. ANA President

Pam Cipriano made reference to this study in her “Inside ANA: From Your ANA President” column in American Nurse Today (2016, January). She noted, “The lower end of that range approximates 10 jumbo jet crashes per week.” Cipriano then discussed the negative impact of harmful workplace cultures on the provision of safe care to patients and the public. According to Cipriano, “changing the workplace culture for the better… is a slow process. But it can be done, particularly with the strength, advocacy and leadership of nurses willing to take on the challenge” (Cipriano, 2016, p. 16).

Presentation on Healthy WorkplacesMeghan Baston’s presentation on promoting healthy workplaces provided an opportunity to consider the evidence, learn about overcoming challenges of harmful workplace cultures and embrace changes leading to positive practice environments. Baton opened her presentation with defining bullying and incivility. She went on to differentiate civility from incivility, with examples of what incivility actually looks like and how it can be quantified. Baston then examined the effects of this behavior on organizations, nurses’ wellbeing and the delivery of safe patient care. The ANA Code of Ethics was discussed, with respect to professional nursing. Baston offered solutions focusing on leaders, both informal and formal. Strategies and scripts using cognitive rehearsal and restructuring were provided and discussed. As she concluded her informative presentation, Baston encouraged nurses to always speak up. The CNP expresses gratitude to Baston for this enlightening and informative presentation.

Culture of SafetyThe NPC has considered means of disseminating this information to our colleagues, as leaders or future leaders and advocates for safety. As readers may be aware, the ANA launched its “2016 Culture of Safety” campaign earlier this year, with the overall theme, “Safety 360 Taking Responsibility Together.” A June 2016 educational offering is being planned to include a focus on the ANA Code of Ethics and culture of safety. The CNP has invited Dr. Pam Cipriano, ANA President, to NH in October to meet with key leaders and attend the NHNA annual meeting and banquet. Dr. Cipriano has accepted our invitation and plans to present on “Culture of Safety” that evening.

ReferencesInside ANA: From Your ANA President. ANA calls for creating a culture of safety

throughout health care. American Nurse Today, 11 (1), 16. James, J. (2013). A new, evidence-based estimate of patient harms associated with hospital

care. Journal of Patient Safety, 9 (3), 122–8. doi: 10.1097/PTS.0b013e3182948a69

Littleton Regional Healthcare, located in the White Mountains of New Hampshire is a desired vacation setting which offers year round recreation

including hiking, fishing, golfing, skiing, snowmobiling, has great schools, and is conveniently located between Boston and Montreal. It’s a place to build a life

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Our healthcare facility has the following RN opportunities: • RNSurgicalServices: Minimum of one year recent OR experience in a hospital

or ASC setting. Candidates with less than one year will be considered for our Perioperative Nurse Intern program. BCLS required, ACLA and PALS within one year. CNOR or completion within one year of hire. Call commitment – must be within 30 minutes of hospital when on call. Current call requirements are one day per week and one weekend every 4-6 weeks.

• RNIntensiveCareUnit: Intensive Care Unit Registered Nurses are responsible for meeting the total nursing needs of the critically ill patient and their family consistent with the policies and procedures of the Department of Nursing and the New Hampshire Nurse Practice Act. Requires a minimum of six months on the job training, if no prior critical care experience with an on-call or in-house backup dependent on patient acuity. ACLS and Cardiac Rhythm Recognition course required before accepting ICU assignment. Critical Care Course within six months. CCRN preferred.

LittletonRegionalHealthcareofferscompetitivecompensation,agenerousbenefitspackageandampleopportunityforprofessionalgrowthanddevelopment.

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Page 18 • New Hampshire Nursing News July, August, September 2016

With a Nurses Day theme of “Seis de Mayo” (Translated: Sixth of May) breakfast burritos were served and there were ice cream sundaes in the afternoon. Two nurses were celebrated as Nurse of the Year and Nurse Leader of the Year. In addition 5 nurses were recognized for their contributions to the mission and vision of the organization including: Leslie Bowen, RN Emergency Services (Transformational Leadership), Renee Glennon, RN 3 West (Structural Empowerment), Angela Chapman, RN 4 East (Exemplary Professional Practice), Sharon Paradis, RN Operating Room (New Knowledge Innovations and Improvements) and Heather Merrill, RN Patient and Family Services (Empirical Outcomes). Ten nurses who had achieved BSN degrees and 8 nurses who had achieved MSN degrees were also acknowledged.

Nurse of the Year

Barbara Hugh BSN RN CCRN was awarded SNHMC Nurse of the Year. Excerpts from her nomination letter included:

“This nurse is a kind and compassionate person who is a mentor of staff that leads her peers by example. She is a pleasure to be around and she is always making people laugh. She has a way of making a bad day great for both patients and staff. She is the nurse that, when you see she is on, you know everything will be OK. She regularly rounds on patients transferred from her area to other units and supports and assists nurses during these visits. She is masterful at inserting IVs and is often called upon by other staff and supervisors to assist with IV placement. Her answer is always a smiling “sure.” She goes above and beyond for her patients, washing and curling their hair, or applying their makeup to meet their personal needs. She personalizes their care often identifying their favorite musical styles and playing them in the room. I remember walking on to the unit and hearing singing and I looked into a patient room and she was singing and dancing for the patient. The joy on the patient’s face was priceless. The patient then stated “that was the best medicine I ever had.” She is committed to early mobilization of even the

Southern New Hampshire Medical Center Celebrates Nurses Week

NHNA Wants to See You….

IN THE NEWSDo you have some news that you want to share with the nurses of New Hampshire? The NH Nursing News accepts short press releases or announcements of your accomplishments.

Did you present at a regional or national conference?

Did you publish in a newsletter or journal?

Did you get promoted?

Did you get certified?

Did you graduate with an advanced degree?

Did you get an award for the best nurse?

Did you get elected to a position in a state, regional or national professional organization?

Did you start a new program? Provide a new service?

Deadline for the next issue is August 15, 2016.

Please send details and a photo if appropriate to office@nhnurses.org.

Maybe you don’t want to blow your own horn, but we do!!!

sickest patients and encourages other staff to make sure they get their patients up early. Recently, she coordinated the effort to bring one of her long term ventilated patients outside to experience the fresh air with family members. From where I stand, if you look into the eyes of this person, what you will see is a passionate, committed and skilled nurse with a gift and a talent for spreading joy and hopefulness in a work environment where the nature of the illnesses treated can make it seem that both are in short supply.”

Nurse Leader of the Year

Ashley Clement MSN RN BC, Clinical Teacher was awarded the Nurse Leader of the Year. Excepts from her nomination letter included:

“She is a high-energy person who is never satisfied with the status quo. She continuously strives to improve herself, her unit, and nursing practice at SNHMC. She is a “go-to” person who will not disappoint you should you seek her assistance. She eagerly mentors staff at all levels to learn new things, to take on informal leadership roles in process improvement, and to embrace unit based practice changes.

She establishes a comfortable learning environment for the new graduates who are very comfortable going to her. She demonstrates patience in orienting them and encourages them to develop critical thinking skills. The combination of her leadership and educator skills has helped these nurses to complete orientation on time and practice independently as beginning nurses. She is a wonderful and committed nurse. She is the reason I love working here. She motivates others to work hard, look things up and be committed to improving the workplace and patient outcomes... She is a great nurse leader.” According to her director, “This nurse makes my job as a director easier and more fulfilling. I am proud to say that she is a member of my leadership team, and I know that I can always count on her to do the right thing to keep the unit functioning well on a daily basis, as well as leading the staff in a positive direction.”

Their StoriesAre Our Stories.

BETTER OUTCOMES AT WORKwww.healthsouthconcord.com

TM

Due to our continued growth, we are always on the lookout for exceptional individuals to join our nursing team. If you are just starting out, or are a current nurse interested in a career in rehab, we have opportunities for you.

At the HealthSouth Rehabilitation Hospital of Concord, we achieve better outcomes by providing our employees with what they need to grow and advance in their profession. Learn more about the difference you can make in your profession as a member of our collaborative team.

Achieve better outcomes for your patients and career by joining the HealthSouth Rehabilitation Hospital of Concord, where we combine superior resources and support to impact your career growth, and the lives of those we serve. We are a 50-bed facility specializing in comprehensive inpatient and outpatient rehabilitation.

July, August, September 2016 New Hampshire Nursing News • Page 19

What does 72 Cents Buy

in 2016

For 72 cents, you can buy 5 gulps of an ice cold Starbuck’s Frappuccino on your way to buy one-third of a gallon of gas. Or you can use your smart phone for about 12 hours while you have half of a finger nail polished during a manicure. Or you can buy membership in the New Hampshire Nurses Association, the only New Hampshire affiliate of the American Nurses Association that advocates for all nurses in the state of New Hampshire.

But why would you join NHNA if you already are a member of other nursing organizations? While other nursing organizations provide a variety of services for their members, NHNA in affiliation with ANA is the largest professional nursing organization, looking out for the interests of nurses in all specialties and roles, wherever and whenever they practice. Specialty organizations are not your PROFESSIONAL organization. The professional association is active in health policy initiatives, such as supporting legislation for safe patient handling to prevent injuries to nurses, advocating for legislation that will allow nurse practitioners and nurse anesthetists to practice to the full scope of their education and promoting legislation to have a nurse on the Health Policy Commission.

NHNA offers networking opportunities and helps to keep all nurses in the state aware of trends in nursing by sending out this newsletter, not just to members but to all nurses. Providing mentoring opportunities for new nurses and maintaining the accredited approver units for continuing education activities are just two of the many programs which NHNA provides to NH nurses. The Commission on Nursing Practice coordinates continuing education programs for student and experienced nurses at a low, low, low price for members.

For your 72 cents you are also a member of the ANA which includes a subscription to the American Nurse Today in addition to all the personal benefits including reduced malpractice rates, books and conferences.

So what will you do with your 72 cents a day? Add your voice to the over 1,000 NH nurses who truly care about their profession? Think about the benefits the next time you drive through the Starbucks window, fill up the gas tank, use your phone or have your nails done! To join go to http/www.nursingworld.org/joinana.aspx

Dr. Pam Cipiriano, ANA President, to visit New Hampshire

The NHNA Commission on Nursing Practice is pleased to announce that ANA President Dr. Pam Cipriano will visit New Hampshire in October, 2016. Her two day visit will allow her meet with key leaders in the state and learn about nursing initiatives. Plans are for Dr. Pam Cipriano to be the keynote speaker at the 2016 Annual Meeting and Awards Banquet, on the evening of October 12th. In alignment with ANA’s 2016 campaign “Safety 360: Taking Responsibility Together,” the organization extended the invitation for this special visit by the ANA leader. NHNA believes that safety is a shared responsibility, and members are looking forward to learning more about key elements, action steps and core values related to safety. As nurses work towards creating a culture of safety, individually and as a group, we share in the ANA campaign and we wish to promote this for our membership.

The New Hampshire Nurses Association Annual Meeting and Awards Banquet takes place every Autumn in Concord, NH. It is open to our members from all over the state. Members attend the annual

meeting and vote on key items impacting the organization. The meeting is followed by our gala event and banquet for members and guests of NHNA, and includes viewings of poster presentations and visiting sponsor tables. A social time of networking is followed by a gala dinner.

NHNA President Peggy Lambert will open the post-dining festivities. Last year we were honored to have keynote speaker, Dr. Susan Fetzer, address the audience on the topic of excellence in nursing. This year, we look forward to Dr. Cipriano’s presentation focusing on a culture of safety. An awards ceremony follows, honoring nurses in NH. Raffle prizes will close the evening event.

We plan to cover aspects of Dr. Cipriano’s visit with media and will feature her visit in NHNursing News. Please see our NHNA website www.nhnurses.org closer to the date, to register for the annual meeting and gala dinner event. We welcome you and look forward to greeting you there.

JOIN OUR TEAM

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NVRH is an Equal Opportunity Employer

Page 20 • New Hampshire Nursing News July, August, September 2016

Let NH Responds connect you to the organization that will best fit

your interests.

ESAR-VHPEmergency System for Advance Registration of

Volunteer Health Professionals

MRCMedical Reserve Corps

DBHRTDisaster Behavioral Health Response Team

MMRSMetropolitan Medical Response System

Emergencies and natural disasters can happen anywhere...

at any time.

Connect with NH Responds to help.

NH RespondsNH Department of Health and Human Services

129 Pleasant Street, Concord, NH 03301Phone (603) 271-9475info@nhresponds.org

Volunteering in an Emergency

WHY REGISTER TODAY

Following a major disaster, communities often need help caring for their residents. During such events, emergency services can be delayed and challenging to access for you, your family, and many of your neighbors and friends.

By joining today, you will become a registered volunteer, whose credentials and identity are verified in advance, making you a valuable resource for your community, state, and the nation.

You will also gain access to specialized training that will provide you with the necessary knowledge and skills needed to safely help people in need.

To find out more information and to register visit www.nhresponds.org