August, September, October 2010 Vermont Nurse Connection • Page 1

June M. Benoit MSN, FNP-C

In war, there are no unwounded soldiers.

~José NaroskyWith so many Vermonters

serving our country in Iraq and Afghanistan, it is hard to find someone without a personal connection to a soldier who is or has been deployed. Most of us also have had family members and friends who have served in other wars. The focus in this President’s Letter is not a political statement on war but a statement on how nurses can help our veterans and their families heal.

The above quote speaks to the reality that no one can truly go to war without receiving some wounds. All war-related experiences threaten the body, mind, and spirit of each veteran. Leaving the comfort of one’s home and family can cause emotional distress. Besides the more obvious physical trauma of the loss of limb(s), soldiers may suffer more invisible trauma: traumatic brain injury, post-traumatic stress disorder, depression that may lead to suicide, combat stress reactions, military sexual trauma, and substance abuse. Health problems as a result of chemical and toxin exposure may take years to surface. Some veterans have more than one deployment. The experience of having to kill, being witness to killing and/or living with the constant threat of being killed can cause spiritual trauma—and deep wounds to the soul which may be hard to heal. We have been taught from early childhood not to harm others; having to participate in such actions can cause intense guilt. Each veteran will have their own unique war experience. Some veterans emerge from their experience stronger and intact, while others are broken. Behind each veteran there are family members, friends, and coworkers who are also affected by having their loved one deployed. Roles within the family are forced to undergo dramatic, sudden change and finances may be more difficult. Children often experience emotional difficulties when a parent is gone or comes back changed. Just dealing with car repair, homework, yard work or simple home repairs can seem overwhelming. Extended families may have difficulty filling the gaps.

Reintegration for each veteran is also a unique journey. Reintegration involves shedding the soldier persona, going from carrying a weapon and being in a constant state of high alert to returning home to resume life as a spouse, partner, parent, child, and an employee. Veterans return to their former life and world that has continued to go on despite their absence. For some, coming back home can be

more difficult than leaving. Despite intensive post-deployment “in-processing,” returning soldiers and their families often experience challenges as lives and families are put back together. Some veterans are reluctant to seek care once home, making the transition even more difficult. There is still a stigma about mental health problems so veterans may be reluctant to admit they actually have problems and may worry it may affect their career. Medications used to treat PTSD, etc may have unpleasant side effects. Families may also struggle in silence.

In my role as a primary care provider at the VA Community-Based Outpatient Clinic in Colchester, I have the privilege to care for these veterans, hear their stories and see the different physical and

current resident or

Presort StandardUS Postage

PAIDPermit #14

Princeton, MN55371

Volume 13 • Number 3 August, September, October 2010 Vermont State Nurses’ Association Offi cial Publication

C. difficile Surpasses MRSA

Page 4

Winner of Nursing Student Essay Contest

Page 6

Inside...

IndexHow Staffi ng Shortages Put You at Risk . . . . . . . 3

Kappa Tau Update . . . . . . . . . . . . . . . . . . . . . . . . 3

C. dif� cile Surpasses MRSA . . . . . . . . . . . . . . . . . 4

Rutland Regional Receives Magnet

Designation . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Personal & Financial Health . . . . . . . . . . . . . . . . 5

Student News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Continuing Education Opportunities . . . . . . . . . 6

General News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ANA/VSNA News . . . . . . . . . . . . . . . . . . . . . . . . . 8

VSNA District Updates . . . . . . . . . . . . . . . . . . . . . 9

Membership Application . . . . . . . . . . . . . . . . . . . 9

The Elephant in the Room . . . . . . . . . . . . . . . . . 10

Specialty Organizations . . . . . . . . . . . . . . . . . . . 10

Vermont Nurse Connection

Quarterly Circulation 25,000 to all Registered Nurses, LPNs, LNAs, and Student Nurses in Vermont

President’s Letter

June Benoit

emotional challenges they face. I have held hands with veterans who weep as they tell me how their life has been irrevocably changed because of their service connected injury. They struggle to emotionally survive as they search for some remnant of their former self to cling to. I have also been amazed by veterans who have been able to overcome those obstacles. The primary and mental health teams of each VA outpatient clinic exist to promote healing and optimal health. Each veteran is screened for possible physical and emotional problems such as depression, suicidal ideations, traumatic brain injury, post-traumatic stress disorder, and exposure to chemicals or toxins. Services and programs evolve as new knowledge emerges concerning war-related conditions. Veterans often provide their own peer support. There are Vet Centers in South Burlington and White River Junction that provide quality readjustment services to veterans and their families that are free and confidential.

Nurses are employed in every health care setting so we are in a unique position to ensure veterans and their families receive all the support they need. Veterans often receive care outside the VA health care system in other primary care settings, outpatient clinics, and emergency rooms. Our fellow nurses may also be veterans. Signs veterans may be having problems include: chronic headaches, dizziness, sensory changes, sleep disruption, confusion, mood changes, emotional detachment, self-imposed isolation, hyper-vigilance, self-medicating and substance abuse. Veterans may exhibit problems performing job duties. Some of these symptoms indicate traumatic brain injury or post-traumatic stress disorder. Nurses also care for the families of veterans. Within each practice setting, nurses need to look for signs families may be in crisis and be able to offer access to appropriate resources. We should not wait for the family members to ask for assistance, we need to open the dialogue and ask questions. Schools may establish special processes to watch for signs of problems in children of veterans. Please assist veterans and families in obtaining help.

Resources:The State of Vermont, Office of Veterans Affairs

assists in caring for Vermont’s veterans by offering assistance with benefits for veterans/families.

The Vermont Guard has developed a comprehensive Family Readiness Program providing an assortment of services that are open to all branches of the military located at Camp Johnson in Colchester, VT. They have established Family Assistance Centers (FAC) at different guard armories throughout Vermont that provide a one-stop shop for information, resources, and referral. Services include financial management, legal referrals, support for children/youth, insurance, crisis intervention and assistance, tax assistance, problem solving, peer connection /support, and assistance with Red Cross Notifications. There is also a Family Readiness Group (FRG), a command sponsored organization at the unit level made up of family members, volunteers, service members, and community members who provide mutual support. They have a Parent Network to help parents and extended families. There are special programs specifically for children and teens. The Guard has chaplaincy services offering direct services to vets and families as well as advising the Command on unit morals and morale affected by religion, impact of religion on military missions, and the ethical impact of Command decisions. The Guard has numerous other programs developed to support service men and women.

Other branches of the military also have family support systems.

President’s Letter continued on page 2

Page 2 • Vermont Nurse Connection August, September, October 2010

The VSNA wants you to take advantage of some of the networking and informational resources available on the Internet.

Current information about activities of the VSNA can be found by visiting the

VSNA Website at: http://my.memberclicks.com/vsna or http://www.vsna-inc.org

Requests for additions or changes to the VSNA website should be communicated before the 1st of each month to the site’s webmaster at vtnurse@sover.net.

Also, as a VSNA member you are welcome to join the VSNA listserv. To become a listserv participant, send an e-mail message to the VSNA office at vtnurse@sover.net. In your message, please indicate that you wish to be part of the listserv and include your name, e-mail address, and your VSNA member number.

Hope to see you on the web!

Voices of Vermont Nurses

premiered at VSNA Convention 2000 and is available from the VSNA Office at:Vermont State Nurses’ Association

100 Dorset Street, #13 South Burlington, Vermont 05403

Price: $20 each book (plus $3.95 for postage and handling)

Make check or money order payable to:VERMONT STATE NURSES FOUNDATION

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Address: _______________________________________

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Vermont Nurse ConnectionOfficial publication of the Vermont State Nurses’ Association.

Published quarterly. Library subscription price is $18 per year. ISSN# 1529-4609.

Editorial OfficesVermont State Nurses’ Association, 100 Dorset Street, #13,

South Burlington, VT 05403, PH: (802) 651-8886, FAX (802) 651-8998, E-mail: vtnurse@sover.net

Editors: Jean E. Graham and Eileen Girling

AdvertisingFor 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. VSNA 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 Vermont State 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. VSNA 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 VSNA or those of the national or local associations.

ContentVermont State Nurses’ Association welcomes unsolicited

manuscripts and suggestions for articles. Manuscripts can be up to: •750wordsforapressrelease

•1500wordsforafeaturearticleManuscripts should be typed double-spaced and spell-checked

with only one space after a period and can be submitted:1) As paper hard copy

2) As a Word Perfect or MS Word document file saved to a 3 1/2” disk or to CD-Rom or zip disk

3) Or e-mailed as a Word Perfect or MS Word document file to vtnurse@sover.net.

No faxes will be accepted. Authors’ names should be placed after title with credentials and affiliation. Please send a photograph of yourself if you are submitting a feature article.

All articles submitted to and/or published in Vermont Nurse Connection become the sole property of VSNA and may not be reprinted without permission.

All accepted manuscripts may undergo editorial revision to conform to the standards of the newsletter or to improve clarity.

The Vermont Nurse Connection is not a peer review publication. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of VSNA or those of the national or local association.

Copyright Policy Criteria for ArticlesThe policy of the VSNA Editorial Board is to retain copyright

privileges and control of articles published in the Vermont Nurse Connection unless the articles have been previously published or the author retains copyright.

VSNA Officers and Board of DirectorsPresident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . June BenoitPast President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .President Elect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Vice President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Carol HodgesSecretary . . . . . . . . . . . . . . . . . . . . . . . . . . . Mary Anne DouglasTreasurer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Jen Botelho District 1 Director . . . . . . . . . . . . . . . . . . . . . . . . Marcia BosekDistrict 2 Director . . . . . . . .Mollie Chamberlain & Katie ClarkDistrict 3 Director . . . . . . . . . . . . . . . . . . . . . . Virginia UmlandVSN Foundation . . . . . . . . . . . . . . . . . . . . . . . . . Lorraine Welch

District PresidentsDistrict 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Jill FedericoDistrict 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . Catherine Ann GuyDistrict 3 . . . . . . . . . . . . . . . . . . . . . .Virginia Umland (Director)

StaffBookkeeper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Martha StewartLobbyist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Margaret Luce

Committee ChairpersonsConvention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lorraine WelchEducation . . . . . . . . . . . . . . . . . . . Deborah Hayward-SanguinettiLegislation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Margaret LuceMembership. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ann LarameeNominating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vacantNursing Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vacantProgram Planning . . . . . . . . . . . . . . . . . . . . . . . . Margaret LucePsychiatric Special Interest Group . . . . . . . . Maureen McGuireCongressional Coordinator . . . . . . . . . . . . . . . . Margaret LuceSenate Coordinator for Leahy . . . . . . . . . . . . . . Margaret LuceSenate Coordinator for Sanders . . . . . . . . . . . . . Margaret LuceANA House of Delegates . . . . . . . . . . . . . . . . . . . . . June Benoit, Carol Hodges, Lorraine Welch, Ellen CeppetelliAlternate Delegates . . . . . . . . . . . . . . . . . . . . . . . Richard Frank

VNC Editorial•JeanGrahamandEileenGirling

Deadlines for the Vermont Nurse Connection

Are you interested in contributing an article to an upcoming issue of the Vermont Nurse Connection? If so, here is a list of submission deadlines for the next 2 issues:

Vol. 13 #4—August 23, 2010Vol. 14 #1—November 22, 2010

Articles may be sent to the editors of the Vermont Nurse Connection at:

Vermont State Nurses’ AssociationAttention: VNC100 Dorset Street, Suite 13South Burlington, VT 05403-6241

Articles may also be submitted electronically to vtnurse@sover.net .

President’s Letter continued from page 1

Resources:Applying for VA health care benefits: 877-222-VETS

(8387) or apply online at www.va.gov/1010EZ.htmState of Vermont Office of Veterans Affairs: 802-

828-3379. www.va.state.vt.usAir Guard Family Readiness Program:

State Family Program Director: LTC Mark Goudreau 802-338-3391 marc.m.goudreau@us.arm.mil

Program Coordinator: Mary Bullis 802-652-8035 mary.bullis@vtburl.ang.af.mil

Family Assistance Center Specialists:• Berlin:JoyceCloutier802-223-2975• Colchester:MaryBlow802-338-3076andLindsay

Jarvis 802-338-3491• Lyndonville:WayneBoyce802-626-8310• Rutland:BethBergeron802-775-0194• Swanton:KarenPelletier802-868-7927

Vet Centers: 1-800-905-4675Vermont Veterans & Family Outreach Program:

1-800-607-8773

If you wish to submit a “Letter to the Editor,” please address it to:

Vermont State Nurses’ Association, Attn: Vermont Nurse Connection100 Dorset Street, #13, South Burlington, VT 05403

Please remember to include contact information, as letter authors may need to be contacted by the editors of the VNC for clarification. NOTE: Letters to the Editor reflect the opinions of the letter authors and should not be assumed to reflect the opinions of the Vermont State Nurses’ Association.

Jean Graham, Editor

August, September, October 2010 Vermont Nurse Connection • Page 3

How Staffing Shortages Put You at RiskYou’ve surely seen the headlines announcing the

nationwide nursing shortage, but have you heard the country is also experiencing an alarming shortage of trained allied health professionals too?

Working in the healthcare field, you’ve undoubtedly encountered a staffing shortage at one time or another. Unfortunately, it appears these shortages may stick around for awhile. The allied health provider shortage is predicted to reach between 1.6 and 2.5 million workers by 2020. 1

What does a staffing shortage mean for you?If you’re working in a setting with reduced staff, you

could encounter one of the following situations:• Youmay be required to care for more patients or

clients than normal• You may need to assume the responsibilities of a

coworker who is absent• Youmaybeexpected tocompletedutiesyoudon’t

normally perform• Youmayhave less time tospendwithyourpatient

or client in order to meet the demand of your practice

Any of these scenarios could impact your ability to provide proper, quality care to your patients and clients. Not only does this compromise them, you become increasingly susceptible to making a mistake—and that puts you at a greater risk for a malpractice lawsuit.

What can you do?Patient and client safety come first. If you feel your

ability to provide quality care is compromised by staffing challenges, you should:• Speakupandaskforhelpifaskedtodosomething

out of your normal scope• Preparefortheshortageaheadoftimeifpossibleby

doing your research and preparing questions• Askfordirectsupervision• Be proactive about sharing information between

clinicians to reduce the risk of miscommunication• Neverleaveyourworkplaceinthemiddleoftreating

your patients or clients

Reduce your liability riskFurther protect yourself and your career with an

individual liability coverage policy. Professional Liability Insurance protects you against covered real or alleged malpractice claims you may encounter from your professional duties.

Even if you have Professional Liability coverage through your current employer, it may not be enough. That coverage may have some serious gaps, including:

• Policylimitsmaynotbehighenoughtoprotectyouand all of your co-workers named in a lawsuit.

• You may not be provided with coverage for lostwage reimbursement, licensing board hearing reimbursement and defense costs.

• Youmaynotbe coveredoutsideof theworkplace,such as volunteer and part-time work.

In the event of a lawsuit, your own Professional Liability Insurance policy would:• Provideyouwithyourownattorney• Payall reasonablecosts incurred in thedefenseor

investigation of a covered claim• Payforapprovedlostwagesuptothelimitsofthe

policy• Providereimbursementofdefensecostsiflicensing

board investigations are involved• Payapprovedcourtcostsandsettlementsinaddition

to the limits of liability

Working in an environment that is understaffed can be difficult and frustrating. Arm yourself with the protection you need so you can focus on providing excellent patient care and reduce your exposure to liability.

For more information about Professional Liability Insurance, visit www.proliability.com.

This article contains a summary of the insurance certificate provisions. In the instance of conflict between this article and the actual certificate, the insurance certificate language will prevail and control.

Reference:1www.recruitingtrends.comThe Professional Liability Insurance Plan is underwritten

by Chicago Insurance Company, a member company of the Fireman’s Fund Insurance Companies.

Kappa Tau UpdateHere is your 2009-2010 board:Ann Laramee, President-ElectSally Kerschner, Vice PresidentChris Kasprisin, TreasurerAlexis Ressler, SecretaryMari Cordes, Newsletter EditorChristina Melvin, Faculty Counselor ChairCathy Muskus, Faculty CounselorJean Beatson, Governance Committee ChairRuby Merali, Governance CommitteeAnnie Parker, Leadership Succession ChairRycki Maltby, Leadership SuccessionLouise Moon-Rosales, Leadership SuccessionMary Botter, Leadership SuccessionVicki Torsch, Awards Committee ChairGene Hicks, Membership Taskforce Chair

Page 4 • Vermont Nurse Connection August, September, October 2010

C. difficile Surpasses MRSA as Leading Cause of Nosocomial Infections in Community Hospitals

Susan Page, MT, MS, CICInfection Preventionist

Fletcher Allen Health Care

Hea lthca re -associa ted Clostridium difficile infections (CDI) have increased in incidence and have surpassed methicillin-resistant Staphylococcus aureus (MRSA) infections in community hospitals according to a recent study presented at the Fifth Decennial International Conference on Healthcare-Associated Infections in March 2010. A large cohort of patients from community hospitals (representing over 3 million patient days) was evaluated from 2008 through 2009; CDI was the most common healthcare-associated infection, closely followed by nosocomial bloodstream infections. Nosocomial CDI occurred 25% more frequently than nosocomial MRSA infection, reflecting both an increase in CDI and a decrease in MRSA since 2007.

In 1935, Hall and O’Toole first isolated a gram positive, toxin producing anaerobic bacillus from the stool of healthy newborns. They named it Bacillus difficilis to reflect the difficulties they encountered in its isolation and culture. We now face the opposite problem of being unable to contain the growth and spread of this organism, which has been renamed Clostridium difficile. It is a common cause of infectious diarrhea, usually occurring as a complication of antibiotic therapy and most often in elderly patients.

The organism produces two exotoxins: toxin A, an enterotoxin and toxin B, a cell cytotoxin. Although pseudomembranous colitis has been the hallmark of infection, the clinical presentation of CDI may range from asymptomatic colonization to severe diarrhea, toxic megacolon, perforation and even death. Nearly all symptomatic patients present with diarrhea, but rare patients, particularly those receiving narcotics following surgery, may have little or no diarrhea due to ileus or toxic megacolon, a late serious complication of CDI.

More than 90% of CDI occurs during or after antimicrobial therapy for an infection; the antimicrobial agents disrupt the endogenous microflora of the intestine, allowing proliferation of C. difficile with resultant toxin

production. Almost all antimicrobial agents, except the aminoglycosides, have been associated with CDI. Fluoroquinolones (ciprofloxacin, levofloxacin) have the strongest association with disease but other agents, including clindamycin, ceftriaxone and other broad-spectrum cephalosporins, are also implicated. The risk increases when patients receive multiple antimicrobial agents and undergo longer courses of therapy. Other factors that increase risk of CDI include advanced age, severe underlying illness, nasogastric intubation, medications that neutralize gastric acid and long hospitalizations. A typical presentation involves an older patient with frequent, loose, watery stools who has recently been treated with a course of antimicrobials while hospitalized for a chronic medical condition. It is estimated that CDI extends a hospital stay by 4 to 14 days.

It has been shown that about 3% of healthy adults asymptomatically carry C. difficile in their intestinal tracts; carriage rate increases to 20% or more in hospitalized patients or residents of long term care facilities. Neonates have a much higher colonization rate, from 5%-70%, but paradoxically are much less likely than adults to develop symptomatic disease due to lack of receptors for toxin A in their immature gut mucosa. Hospitals and long term care facilities have the highest rates of CDI, and this complication is often endemic or even epidemic in these facilities. This association is not surprising because large populations of patients or residents with high rates of exposure to antimicrobial agents are housed in close proximity in facilities with widespread contamination with C. difficile spores that persist in the environment for years. These patients or residents are often attended by healthcare workers who carry the spores on their hands and medical equipment. These factors emphasize the importance of hand hygiene and thorough environmental cleaning in controlling the spread of C. difficile.

The diagnosis of CDI is usually established by detection of C. difficile toxin A or B in stool. Most laboratories in this country use an enzyme immunoassay (EIA) to detect toxin A, or toxins A and B. EIA is a very specific test (very unlikely to yield a false-positive result) but lacks sensitivity (30% or more of specimens yield false-negative results). Because toxins A and B are very unstable at room temperature, specimens should be sent to the lab as soon as possible or refrigerated. A much more sensitive and specific test for the presence of C. difficile toxin, known as polymerase chain reaction (PCR), has recently become available. This assay tests for the presence of the gene that codes for the toxin production of C. difficile.

It should be noted that while testing for C. difficile toxin is highly effective in establishing the diagnosis of CDI, it has not been useful for evaluating response to therapy or as a “test of cure.” The reasons for this are unclear, but therapeutic decisions are best made on the basis of clinical response.

Occasionally use of either CT scan or endoscopy may be useful adjuncts in diagnosing CDI. Colonoscopy (preferred over sigmoidoscopy) may show the presence of pseudomembranes, a late and serious complication of C. difficile. CT imaging may show characteristic features such as thickening of the colonic wall (indicating colitis), absence of small bowel involvement and the presence of ascites.

During the last decade an alarming trend in CDI, marked by increasing rates of disease, more severe and complicated cases, and diminishing responses to standard therapies, has been observed. This changing epidemiology has been associated with the emergence of a new strain of C. difficile, referred to as the NAP1 strain based on its pulsed field gel electrophoresis pattern. The NAP1 strain of C. difficile produces up to 20 times more toxin than seen with other strains and is highly resistant to fluoroquinolones, including the newer gatifloxacin and moxifloxacin. This strain is also capable of hyper-sporulation, resulting in widespread environmental contamination. First described in a wide-spread outbreak in Quebec, Canada, the Centers for Disease Prevention and Control (CDC) has since reported outbreaks of this epidemic strain in at least 38 states. Although Vermont is not included among those states, we have certainly seen the increase in cases and severity of disease associated with this strain. Since 2001, discharge data from United States hospitals has shown a sharp increase in rates of CDI with the rates doubled by 2003. The increased rates are twofold higher in persons aged 65 or older. During outbreaks of severe disease, an increased number of patients required colectomies and significantly more deaths were associated with CDI. During a 2002 outbreak in Montreal, patients with CDI spent an additional 7 days in the hospital; 10% required admission to an ICU and 2.5% require emergency colectomy. Severe cases of CDI

have also been reported in populations previously believed to be low risk for CDI, including peripartum women and otherwise healthy persons living in the community, some with no documented prior antimicrobial exposure.

Prevention and control of C. difficile includes three prongs: judicious use of antimicrobials, adherence to meticulous infection control practices for hand hygiene and contact precautions, and thorough cleaning and disinfection of the environment. During episodes of diarrhea, C. difficile is shed in the feces of patients and can contaminate the environment and ultimately, the hands of healthcare workers. Once outside the body C. difficile readily forms spores, which may persist in the environment for very long periods of time. Although the spores may be removed by vigorous mechanical cleaning, they are not killed by the commonly used hospital-grade disinfectants. If a healthcare facility is experiencing an increase in CDI, CDC recommends considering use of a fresh 10% dilution of household bleach for disinfection of patient rooms, as bleach does show some efficacy in killing spores. Because of the corrosive nature of bleach, it must be used carefully and long-term use may cause problems, particularly with metal surfaces.

The formation of spores also impacts hand hygiene, as the alcohol-based hand sanitizers currently recommended for healthcare are not sporocidal. If a healthcare facility is seeing an increase in CDI, CDC recommends that staff wash their hands with soap and water after glove removal, as this will mechanically remove any spores that may be present. Patients diagnosed with CDI should be placed in a private room, or cohorted with another patient with CDI, and cared for using contact precautions. Gowns and gloves should be worn by all healthcare workers providing care in these rooms; equipment such as stethoscopes and blood pressure cuffs should not be used on other patients without appropriate disinfection.

Because prior exposure to antimicrobial agents is a major risk factor for CDI, all healthcare facilities should periodically review their prescribing patterns and consider an antimicrobial restriction program. CDC estimates that between 20%-50% of all antimicrobials prescribed in this country are unnecessary. In particular, judicious use of clindamycin, third-generation cephalosporins such as ceftriaxone, and the fluoroquinolones may help reduce the risk of CDI.

Treatment of CDI must include two strategies. The most important first step, whenever possible, is discontinuation of the offending antimicrobial. This allows the normal bowel flora to reestablish itself. The second component is antibiotic therapy directed against C. difficile. Empiric therapy should be initiated as soon as a diagnosis of CDI is suspected. Oral metronidazole (Flagyl) has historically been used as first-line therapy, but it may be associated with both increased failure rates and increased recurrence rates. It is still recommended as the first-line agent for treatment of mild CDI. Oral vancomycin is recommended for treatment of severe disease defined as a marked leukocytosis, acute renal failure, hypotension or pseudomembranous colitis. For patients with severe disease who develop ileus, traditional treatment with oral or intravenous agents alone may not be sufficient, as fecal concentrations of antibiotics are inconsistent. Intravenous metronidazole should be used in combination with vancomycin administered via nasogastric tube or rectal instillation. Severe complicated disease has resulted in an increased number of colectomies and deaths. An early surgical consultation should be considered in patients with ileus or marked leukocytosis.

Despite successful therapy initially, up to 35% of patients will have a recurrence; after the second recurrence, the incidence of subsequent recurrence may be as high as 65%. Most cases of initial recurrence can be retreated with the same agent used initially, as these do not appear to be related to in vitro resistance. A combination of strategies may be needed to treat multiple episodes of recurrent disease; these include tapered or pulsed dosing of vancomycin and use of adjunctive therapies such as probiotics, intravenous immunoglobulin and fecal replacement therapy.

Increasing rates of CDI, more severe disease, and the emergence of a virulent, resistant strain of C. difficile are presenting healthcare providers with new challenges in the management of CDI. Nurses must remain abreast of current epidemiologic trends and recognize the global effects of indiscriminate antimicrobial use. We should work to promote and practice proper infection prevention and control measures including increased attention to appropriate environmental decontamination as well as meticulous hand hygiene and adherence to contact precautions.

Susan Page

Rutland Regional Receives Magnet Designation

Rutland, VT—Rutland Regional Medical Center has earned Magnet designation for excellence in nursing by the American Nurses Credentialing Center’s (ANCC) Magnet Recognition Program®. Only 5 percent of hospitals nationwide have been granted Magnet status, one of the highest achievements an organization can obtain in professional nursing.

Magnet candidates undergo a rigorous and lengthy application and evaluation process that includes extensive interviews and review of all aspects of nursing services. In September 2009, Rutland Regional Nursing submitted more than 900 pages of nursing evidence and documentation to the ANCC. After reviewing the submitted documents the ANCC visited Rutland Regional February 10-12, 2010 to see the evidence in action.

To earn Magnet designation, a hospital must demonstrate a commitment to excellence on all levels of nursing practice and adhere to national standards for organization and delivery of nursing services. Magnet hospitals are recognized for building and supporting evidence-based practice models, advanced training, and measuring outcomes proving the quality patient care they provide. The Magnet designation is valid for four years, during which time the ANCC monitors the hospital to ensure that high level of patient care standards remain. The ANCC is the largest and most prominent nursing credentialing organization in the United States.

August, September, October 2010 Vermont Nurse Connection • Page 5

MDI Launches Web-Based Tool for End-of-Life CareMadison-Deane Initiative (MDI), a program of the

Visiting Nurse Association of Chittenden and Grand Isle Counties (VNA), announced the launch of a new website designed to help individuals and families find information and resources about palliative and end-of-life care. Vermont Palliative and End-of-Life Care Resource Connections, www.vtpcrc.org, was created by Madison-Deane Initiative (MDI) with support from the Vermont Palliative Care Collaborative of the University of Vermont College of Medicine.

Designed for lay people and professionals alike, the Vermont Palliative and End-of-Life Care Resource Connections website offers valuable information and connects people to end-of-life care resources available in Vermont. Patients, their families and caregivers can learn about palliative and hospice care options, get reliable information, find community services, locate providers, access supports, and identify learning opportunities.

The mission of Madison-Deane Initiative is to transform end-of-life care through education, collaboration and inspiration. MDI seeks to be responsive to emerging needs, to future challenges and to opportunities to increase understanding about end-of-life care issues as they arise in our community. For more information about MDI, please contact Madison-Deane Initiative at 860-4419, or visit the VNA website at www.vnacares.org.

Personal & Financial HealthEffective Meetings:

How To Take Your Next Meeting From Worn-Out To Wow!Susanne Gaddis, PhD

If you are currently experiencing an acute case of “MBO” (also known as “Meeting Burn-Out”), you’re not alone. And it’s no wonder—many meetings are inefficient, boring and end up wasting your valuable time. Anticipating a long, drawn-out meeting can make even the most highly motivated employee unhappy, discouraged, and at the very least, a tad annoyed. If the thought of your next meeting leaves you filled with an overwhelming sense of dread and your stomach in knots, it may be the perfect time to learn and integrate some of the following meeting tools, techniques and tactics. Whether you’re the meeting planner or you just want to perk up your participation during your next meeting—here are some tools, techniques and tactics specifically designed to help you make the most of every meeting minute.

Set a Positive Emotional ContextIndividuals responsible for running meetings should be

aware of the powerful influence that positive emotions can have on the success of any meeting. According to Michael McCormick, Ph.D., a personal effectiveness coach and organizational psychologist at the University of Houston-Clear Lake: “No one has ever considered the importance of positive emotions and how they affect the dynamics of the meeting. This may indeed be the missing link.” Contrary to what most people believe, effective meetings are no longer just about distributing a clear agenda in advance, rather it’s about setting a positive emotional context for the meeting. By deliberately or intentionally creating a positive meeting environment, we can enhance the positive moods of meeting participants. “Take a typical revival meeting for example,” said McCormick, “before anything formal is said, there is a whole lot of singing, clapping and planned activities to elevate mood states of participants.” McCormick’s words are echoed by Barbara Fredrickson, Ph.D., associate professor of psychology at the University of Michigan who has completed extensive research on the impact of positive emotions on learning and cooperation within groups. Fredrickson’s research reveals that when people are experiencing positive emotions such as optimism, joy, contentment, gratitude, and/or a sense of personal accomplishment, they are more creative and willing to collaborate, they learn new information faster and their problem solving skills improve.

Elevating The Mood Of Your AttendeesWhile singing and clapping may not necessarily be

appropriate for your next meeting, there are things that can be done to elevate the mood of meeting participants. These include:

1) Designate an official greeter. The greeter’s task is to arrive 15 minutes prior to the start of each meeting to make sure that the room is in order. They then will personally greet each participant as they arrive, as well as introduce them to others in the room. The greeter can also make sure that each individual has a copy of the agenda and all other items that will be necessary to fully participate in the meeting.

2) In large group meetings, provide name badges or name plates. This assures that each person is made to feel like an important part of the group. This also makes it easier for individuals to address each other throughout the meeting.

3) Offer refreshments. Coffee. Tea. Water. Juice. Cookies. This small gesture can go along way toward creating goodwill. Plus, it raises the attendees blood sugar level thereby making them more alert.

4) Play music as people arrive. The right music can elevate moods and serve to set a positive context for sharing. If your meeting has a theme, consider choosing music that captures the theme.

5) Consider your meeting room’s interpersonal atmosphere. If you’re trying to generate creative ideas in a boring, white-walled room, you may want to consider what elements could be added to warm up the atmosphere and create a more friendly and festive environment. Wall art, seasonal decorations, your company logo and mission statement can all serve to create a different atmosphere.

Other ideas that will take your next meetingfrom good to great:

Realize That Timing is EverythingIt’s important to start and end every meeting on time.

Do this regardless of who has shown up. By making this a policy, it allows people to relax and gives them a measure of control over the meeting. By following a rigid time structure, individuals will know that you value their time. Should latecomers arrive, don’t interrupt the flow by making too much of a fuss, rather greet them by name as they enter the door and invite them to sit and participate by sharing with them where you are on the agenda. (e.g., “Hello Bob, come in and join us, we were just discussing item B on the agenda.”)

Establish Ground RulesDepending on the size of your group and the number of

times that you will meet, it may be a good idea to establish meeting “ground rules.” Here participants are asked to generate a list and agree on what things need to occur in order for the meeting to be effective. Typical ground rules might be: Each participant is expected to arrive and depart on time; only items on the agenda may be discussed; no cell phones can be used; everyone must listen respectfully; and everyone is responsible for reinforcing ground rules. (As a reminder, ground rules may be displayed at subsequent meetings.)

Stick to the AgendaDesignate a timekeeper to keep the meeting on track.

You can designate the specific time an agenda item will be discussed next to each agenda item. The timekeeper is responsible for keeping all members on task and their efforts should be positively reinforced by all members.

Conduct a Positive Check-inSuccessful groups focus on relationships first and tasks

second. Knowing this, you may want to experiment by reserving several minutes at the beginning of each meeting to conduct a “positive check-in.” During this, all meeting participants are invited to share a positive (personal or professional) experience that they have had since the last meeting. The positive experience could include a positive experience with a loved one, something that has happened on the job or in their personal lives, etc.

Iron Out Personality Conflicts Outside of the MeetingFace it. There are some people that get on our last

nerve. Unfortunately, they may be at your next meeting. If you know that a person has a history of negativity and of offering long-winded comments that bring down the emotional state of the meeting participants, consider talking with the person one-on-one prior to the meeting to express your concerns and your expectations. Rather than airing your dirty laundry in front of the group, by taking the initiative up front to discuss whatever ails you, you will be much better off in the long run.

Hold a Positive Check-OutRather than finishing up the final agenda item

and rushing people out the door, you can enhance the perception of a successful meeting by reserving three to five minutes at the end to hold a “positive check-out.” Here, you will provide everyone with an opportunity to find out how to better work together, by asking: “What worked? What didn’t work? What can we do differently next time?” Another approach to a “positive check-out” is to ask each meeting participant to acknowledge one thing that went well during the meeting. This can include acknowledging another person’s contributions or ideas, acknowledging how the meeting flowed, expressing their excitement or appreciation for meeting results, etc.

Check Your Attitude at The DoorYou don’t have to be a “positive Pollyanna,” but you do

need to know that carrying a positive attitude with you to every meeting can work to your professional advantage. So, the next time you’re invited to a meeting, check your attitude prior to reaching the door. If you are the person who consistently “badmouths” any meeting—without knowing it, you may be working against yourself. To gain a new perspective, set yourself up to listen. Key questions to ask are: “What is being said that I need to know?” and “How do the points being shared during this meeting relate to what I already know?” By asking yourself these

questions, your brain will actively seek to find answers. As each point on the agenda is presented, ask yourself, “What positive contribution can I make?” A pair of excellent questions to ask yourself prior to speaking up are: “Does what I’m about to say directly relate to the topic at hand?” and “What is my point in sharing this information?” If you can contribute to the conversation by offering an important insight or fact, do so. However, when taking the floor, make sure to keep your comments brief and to the point. As we all know, there is nothing more irritating than being in a meeting where one or two people rant and ramble with no end in sight. In conclusion, keep in mind that with every thought, word and action we either positively affect or negatively infect a meeting’s effectiveness. So make a positive choice today to make the most out of every meeting’s minutes!

Susanne Gaddis, PhD, known as the Communications Doctor, is an acknowledged communications expert who has been speaking and teaching the art of effective and positive communication since 1989. Gaddis’ workshops, seminars, and keynote presentations are packed with tips and techniques that can be immediately applied for successful results. Gaddis also provides quality training and executive coaching for organizations, corporations, and associations across the United States. For more information, call 919-933-3237 or visit www.communicationsdoctor.com.

Susanne Gaddis

Page 6 • Vermont Nurse Connection August, September, October 2010

Student NewsThe Vermont State Nurses’ Foundation

AnnouncesThe Arthur L. Davis Publishing Agency, Inc.

2010 ScholarshipApplications for the $1,000 scholarship are open to Vermont State Nurses’ Association members who are currently enrolled in an undergraduate or graduate nursing program and who are active in a professional nursing organization. Submit application by August 1, 2010. Please complete the application below and submit it to:

Vermont State Nurses’ Foundation, Inc.100 Dorset Street, Suite #13South Burlington, VT 05403

Name: ______________________________________________________________________________

Address: ____________________________________________________________________________

City: __________________________________ State _______________________ Zip ______________

Phone: ______________________________ E-mail: _________________________________________

Nursing Program and Degree Currently Enrolled in:

____________________________________________________________________________________

Briefly describe your activities in the Vermont State Nurses’ Association or other nursing organization within the past three years:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Nurse Practitioner Eligibility has been

Expanded for the NHSC Scholarship Program

The NHSC Scholarship guidance has been expanded from Family Nurse Practitioner to include Nurse Practitioners specializing in adult, family, geriatrics, pediatrics, psychiatric, or women’s health.

Please see the updated guidance: http://nhsc.hrsa.gov/scholarship/guidance/eligibility.htm.

Nurse Practitioners are eligible for the NHSC Scholarship if they are pursuing a master’s degree, or post-master’s certificate, accredited by the National League for Nursing Accrediting Commission or the Commission on Collegiate Nursing Education, leading to national certification as a Nurse Practitioner specializing in adult, family, geriatrics, pediatrics, psychiatric, or women’s health by either the American Nurses Credentialing Center or the American Academy of Nurse Practitioners.

Hollie Shaner-McRae Nursing Student Essay

ContestHollie Shaner-McRae,

DNP, RN, FAAN attended the CleanMed 2010 conference in Baltimore Maryland on May 12-13th.

In an effort to spread the word to nursing students of the important role nurses can and do play in advocating for environmental health goals, the Nurses Work Group of Health Care Without Harm, along with The Luminary Project, has created the Hollie Shaner-McRae

Nursing Student Essay Contest. In an essay of 600 to 1500 words, the contestants were asked to discuss the nurse’s role as an environmental health activist.

Hollie Shaner-McRae

Continuing Education Opportunities

The Vermont Cancer Center presents:The 13th Annual Breast Cancer Conference

Date: 10/15/2010, 8am-4pmLocation: The Sheraton Burlington Hotel &

Conference CenterBurlington, VT

The conference theme is “Breast Cancer, the Environment & You: Genetics, Toxins, Nutrition & Exposure.” This

FREE community event offers over 60 educational sessions and a full exhibits fair. AMA, AAFP, Nursing

Contact Hours, and Social Worker Credit tentatively available.

For more information, visitwww.VTBreastCancerConference.org

or call 802-656-2292.

Integrated Systems of Care:Improving Quality and Efficiency

Date: 09/24/2010Location: Sheraton Conference Center

Burlington, VT

8th Annual Northern New England Critical CareDate: 09/29/2010-10/02/2010

Location: Stoweflake Hotel and Conference CenterStowe, VT

Advanced Dermatology for the Primary Care Physician

Date: 10/07/2010-10/10/2010Location: Sheraton Hotel & Conference Center

Burlington, VT

Upcoming Educational Opportunities (Non-VSNA)

UVM College of MedicineThe following educational events are sponsored by the University of Vermont. For more information contact:

Continuing Medical Education128 Lakeside Avenue, Suite 100

Burlington, VT 05401(802) 656-2292

http://cme.uvm.edu

Neurology for the Non-NeurologistDate: 10/22/2010

Location: Portland Regency HotelPortland, ME

Bridging the Divide: A Conference Fostering Collaboration between Primary Care, Mental Health,

Substance Abuse, and Behavioral HealthDate: 11/16/2010

Location: Sheraton Hotel & Conference CenterBurlington, VT

August, September, October 2010 Vermont Nurse Connection • Page 7

General NewsVermont Legislative Summary May 2010

Margaret Luce, MSN, RN

VSNA Nurses’ Day at the State House on April 7 drew 106 registered nurses! John Tracy, former chair of the House Health Committee and currently Senator Leahy’s staff person for health affairs, led a discussion of the federal health care reform legislation. Nurses were able to attend legislative committee meetings. There was a Resolution honoring nurses, and nurses were introduced in the House of Representatives. The Senate Committee on Health and Welfare had a spirited debate on S. 88 Health Care Reform, which went through a number of amendments, but ultimately passed. Nurses’ Day at the State House is intended to increase the ability of nurses to advocate in the political arena for patients and nurses. VSNA is gratified that each year the number of nurses attending Nurses’ Day has increased.

The 2010 legislative session was heavily influenced by the budget deficits of the State of Vermont, and legislators expect the 2011 session to be difficult for the same reason. The Agency of Human Services had a big reduction in its budget and nurses will probably see some of the fallout as community services for the aged and disabled will be reduced. The Vermont Department of Health proposed a reduction in loan repayment amounts for education of nurses and other health care providers. It is hoped that the money will be made up by federal funds from health care reform legislation.

This year there is some concern about new graduates being able to find jobs, as more experienced RNs increase their hours or delay retirement related to the downturn in the economy. Over all, there is a need, and it is predicted that there will be a greater need, for more registered nurses in the future to keep pace with the aging Baby Boomer generation, increased acuity of patients, meet the demand for health promotion and disease prevention, and the retirement of RNs. Linda Aiken, Ph.D., RN, in her latest research, again demonstrates the importance of

adequate RN staffing to patient outcomes, with increases in mortality when nurses care for too many patients.

VSNA advocated for H. 268, a bill that proposed to prohibit mandatory overtime for certain health care employees of health care facilities. The testimony was compelling, and numerous nurses came forward to describe how they were coerced into staying longer than their 8 or more often 12 hour shifts. Employees at the Vermont State Hospital, which lost its CMS certification five years ago, testified to the effect of mandatory overtime on nurses and patients. Unfortunately, the bill did not progress but hopefully will be introduced again in 2011.

H. 435 (Act 61) Palliative Care and Pain Management, which passed in 2009, is being implemented. Vermont Ethics Network offered a conference on the survey of resources available to patients and families; and the Madison-Deane Initiative at Chittenden-Grand Isle VNA has created a web site of resources. VSNA Convention 2010, October 13 and 14 at the Hampton Inn, Colchester, will focus on caring for patients who need palliative care and pain management across the life span.

H. 88 Health Care Reform passed, and has authorized the Joint Commission on Health Care Reform to hire a consultant to design three ways the state could offer health insurance that would assure all Vermonters would be covered. The public insurance option is one of the insurances included for study.

Legislators expanded the Blueprint for Health, a primary care program offered in collaboration with the Vermont Department of Health that focuses medical care on prevention and chronic care management designed to improve outcomes and decrease cost of care. Blueprint for Health teams in primary care practices consist of physicians, registered nurses, dieticians, and social workers.

SAVE THE DATE: NURSES’ DAY AT THE STATE HOUSE APRIL 20,2011

Research Round-UpThe VNC welcomes the submission of nursing abstracts of

publications, reports, theses or other scholarly work. The VNC is distributed to 25,000 readers, and it is a wonderful way to share your work and to keep us informed of the wealth of work that nurses are producing throughout Vermont.

The VNC Editorial Board encourages all nurses involved in practice, education, research, administration or other fields to submit their typed abstracts of 200-250 words with a cover letter with the following information:

• NameandCredentialsofAuthor:• Telephone#:• Emailaddress:• PlaceofEmployment:• Position:• Educationalinstitution(ifstudent):*• CurrentYearofStudy:• Facultycontactperson: Name: Telephone #: Email address:• Date:*StudentAbstractsmustbesubmittedbytheirschoolof

nursing.Abstracts may be e-mailed to vtnurse@sover.net, or a

hardcopy can be sent to the VSNA, Inc, VNC Abstract, 100 Dorset Street, # 13, South Burlington, VT 05403.

Save the Date

The president of the Vermont State Nurses Association, June Benoit invites you to attend the Association’s 96th Convention. It will be held the evening of October 13th and all day October 14th at the Hampton Inn in Colchester, Vermont. The Convention Committee selected the theme, Pain Management and Palliative Care in recognition that nurses are at the front line for improving clinical care for patients in need of pain management and/or palliative care. The educational sessions address a range of topics each adding to nurses’ understanding of current

interventions and strategies for impacting the quality of life for patients. The speakers, from a number of disciplines, will discuss both traditional medicine and complementary and alternative modalities for children and adults.

Vermont State Nurses’ Association’s Convention not only provides important education but is also a great chance to interact with the experts, see a wide range of exhibits, network with nurses around the region, enjoy a comfortable environment with some good food, and maybe do some holiday shopping. Look for the Convention brochure in your mail that will outline the program. Contact hours will be awarded for the education sessions.

The Vermont State Nurses’ Association is an approved provider of continuing education by the South Carolina Nurses Association an accredited approver by the American Nurses Credentialing Center’s Commission.

Vermont State Nurses’ AssociationConvention 2010

Nurses Making a Difference for Patients in Need of PainManagement and/or Palliative Care

Page 8 • Vermont Nurse Connection August, September, October 2010

ANA/VSNA NewsIn Recognition of Caring—Honor a Nurse by Making a Contribution to the Vermont State

Nurses’ Foundation Scholarship Fund

During National Nurses’ Week, May 6-12, 2009, the Vermont State Nurses’ Foundation (VSNF) launched a campaign to recognize nurses who excel in building a healthy Vermont. Patients, families and communities are grateful but thanks from colleagues or coworkers for the significant impact the nurse has on the health of Vermonters also has a special meaning.

Give a gift to the Vermont State Nurses’ Foundation to support nursing scholarships in that nurse’s name. It is suggested that a minimum gift of $25.00 for each nurse or a $100.00 for a group of nurses be made to the Foundation. These nurses will be honored and you will be acknowledged for your donation to the Foundation at the Vermont State Nurses’ Association Convention at the Hampton Inn in Colchester, Vermont on October 13 & 14, 2010.

All names of nurses must be submitted by September 20, 2010. Please mail the form and check to the:Vermont State Nurses’ Foundation100 Dorset Street, Suite 13South Burlington, VT 05403

Thank You!

I am honoring:

Name: _________________________________________________________________________________________

Address : ______________________________________________________________________________________

City/Town: ________________________ State: _______ ZIP Code: _________ Phone: ______________________

This nurse is building a healthy Vermont by: __________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

Donor’s name: __________________________________________________________________________________

Address: _______________________________________________________________________________________

City/Town: ________________________ State: _______ ZIP Code: _________ Phone: ______________________

Vermont State Nurses’ Foundation Awards Two

ScholarshipsTwo nurses, matriculated students in masters

programs were awarded scholarships at the Vermont State Nurses’ Association Convention on November 12, 2009 held at the Stoweflake Resort and Conference Center in Stowe Vermont. The nurses, Terry Powers Phaneuf, winner of the Arthur L. Davis Scholarship and Carmel Thomas, winner of the Pat and Frank Allen Scholarship are both employed at Fletcher Allen Healthcare.

Terry Powers Phaneuf, RN, BSN, CCRN is currently a full time nurse educator in the Inpatient Rehabilitation Center. She is an active member of District I, Vermont State Nurses’ Association, the Association of Rehabilitation Nurses and the Kappa Tau Chapter of Sigma Theta Tau International, the Honor Society of Nursing. She is also involved in a nursing research study describing the process by which an electronic health record is implemented.

Carmel Thomas, RN, BSN is currently an assistant nurse manager on a general surgical unit. She participated in the Leadership Institute at Fletcher Allen Healthcare and then began her graduate studies in nursing at the University of Vermont. She is working on changing the health care delivery system on her clinical unit to improve patient and staff satisfaction and to improve patient outcomes. She also has had experience teaching junior nursing students which she enjoyed.

Congratulations to these nurses! The Board of Trustees of the Vermont State Nurses’ Foundation extend their best wishes for continued success in their nursing careers.

VSNA 2010 Clinical Excellence Awards

Norwich University, BSN—Brooke BentoCastleton State College, ADN—Jillian GreenoSouthern Vermont College, ADN—Jamie RogersVermont Technical College, ADN—Russ G. HoermannUniversity of Vermont, BSN—Jamie SharpeUniversity of Vermont, MSN—Tristin Adie

August, September, October 2010 Vermont Nurse Connection • Page 9

ANA/VSNA News

IS YOUR NURSING ORGANIZATION PLANNING

ANEDUCATION PROGRAM?

CONSIDER APPLYING FOR CONTACT HOUR APPROVAL

FOR MORE INFORMATION CALL THE VSNA OFFICE

@ (802) 651-8886

Vermont State Nurses’ Association, Inc. is accredited as an approver

of continuing education in nursingby the American

Nurses’ Credentialing Center’sCommission on Accreditation.

Vermont State Nurses’Association, Inc.

The Voice for Vermont

Nurses

Providing:

• Opportunity to network with Nurse Professionals

• VSNA Annual Convention

• Vermont Nurses’ Day at the State House

• Annual Awards recognizing individuals who have made outstanding contributions to the nursing profession in Vermont.

• Education Programs

• Contact Hour Approval

• Lobbying

• The Vermont Nurse Connection, our offi cial organization publication

Purposes• Work for the improvement of health

standards and the availability of health care services for all people.

• Stimulate and promote professional development.

• Serve Vermont nurses as the constituent association of the American Nurses Association.

These purposes shall be unrestricted by consideration of nationality, race, creed, lifestyle, sex or age.

VSNA/ANA Membership Benefits

Advocating for Nurses

American Nurse Today

Credit Card Program

Education

OJIN: The Online Journal ofIssues in Nursing

Political Representation in Vermont and Washington, D.C.

Reduced liability insurance ratesplus options on life, disability, retirement, auto.

Reduced fees for workshops and conferences with Continuing Education Contact Hours.

Reduced cost for ANA certification.

Reduced rates on ANA publications including Standards of Practice.

The American Nurse

Travel Discounts

Workplace Health

v tnurse@sover.net

VSNA New MembersDistrict 1Kathy Briggs Dennis GerbanaSue GoetschiusKatherine Kasowitz

District 3Kristi Kligerman Melissa Prouty

Date of Activity Status of Title of Activity Sponsoring Application Organization

26-March-10 Approved Clinical Transformation & Implementation Vermont Information Training & Education Technology

4-May-10 Approved Vermont Cardiac Network Vermont Cardiac 2010 Spring Conference Network

15- March -10 Approved Professional Lactation Conference Lactation Consultant Association

29-April-10 Approved Infection Connection: Building the Future APIC New England

14-May-10 Approved Seminar for Bereavement Counselors Massachusetts Center for in Massachusetts SIDS

18-June-10 Pending Highlights of the Society of UVM, Vt Cancer Center Clinical Oncology

Contact Hour Approvals

VSNA District UpdatesDistrict 1 Update

District 1’s Annual Meeting was held on Wednesday, May 5th, at the Doubletree Hotel in South Burlington. Mari Cordes gave a presentation on Nursing Experiences in Haiti, post earthquake. New officers elected at the meeting were Jill Federico, President and Mari Cordes, Secretary. Nominating Committee members are Peg Gagne and Maureen Tremblay. The District I slate of officers are: Jill Federico, President, Irene Bonin, Vice President, Martha Jo Hebert, Treasurer and Mari Cordes - Secretary. Marcia Bosek is the District I Director. Hollie Shaner-McRae completed her term as President. It was a great time for District I members to renew professional connections.

District 2 UpdateDistrict 2 held their annual meeting on May 6th at

Lucia’s Italian Restaurant in Barre, VT. Mari Cordes, RN gave a slide show of her trip to Haiti where she participated in the earthquake relief effort.

Cindy Bullard has joined the District 2 Board as Secretary. Catherine Ann Guy is still president, Diana Hamilton is Vice-President, Jan Oliver is Treasurer, and Katie Clark and Mollie Chamberlain are sharing the position of district director.

District 3 UpdateDistrict 3 held a very successful Annual Meeting

on May 18, 2010, in Bennington, Vermont. The group discussed ways to support the Ask a Nurse Campaign that will add membership to our organization. Meeting dates were set for the fall:

• Wednesday, September 8, 2010, at 6:00pm inSpringfield, place to be determined, and

• Thursday,November4,2010,at6:00pminRutland,place to be determined.

Please monitor the calendar on the VSNA website for location information.

District 3 members are asked to log on to the VSNA website and make sure contact information is current, especially email address. Email is an easy way for the board to distribute information and meeting notices, so please help out by making sure your information is correct. Thank you for your support!

Leah MattesonKimberly RatelleMonique Van Leuven

(Membership in VSNA only; make check payable to VSNA)

Make check payable to ANA/VSNA

Page 10 • Vermont Nurse Connection August, September, October 2010

The Elephant in the Room: Huge Rates of Nursing and Healthcare Worker Injury

Reprinted from UNA newsletter

Nearly all of us are aware of nurses with back pain—or we may suffer from it ourselves. What we may not realize is how enormous the problem is. This article is dedicated to educating nurses about the risks they and their co-workers face in performing routine patient care. We’ll also give you information about what you can do to help: you and your co-workers.

“My name is Elizabeth White. I am an RN who graduated in 1976 from the BYU College of Nursing. In December, 2003, I was working in the Surgical ICU at Arrowhead Regional Medical Center, the San Bernardino, California county hospital. My assignment that night was a 374 lb patient who was on a ventilator and also on spinal precautions. I was able to get help to turn and bathe him only once that shift. However, because he was on spinal precautions his mattress was flat, but had to be in reverse Trendelenberg because of the vent. He slid down to the foot of the bed, of course. Only one other staff member was available to help pull him away from the foot of the bed. By the end of the shift, I was in so much pain I could hardly walk. I ended up leaving clinical nursing: nearly six (6) years later I still have pain on a daily basis.”

Last year, over 71,000 nurses suffered a back injury—but these are only the injuries that can be directly traced to work. 48% of nurses complain of chronic back pain, but only 35% have reported a work related injury.i Many of the injuries will simply be endured by nurses and health care givers, with no recourse to any compensation. The cumulative weight lifted by a health caregiver in one typical eight hour shift is 1.8 TONS.ii Back injuries

are incremental and pain often presents in unrelated circumstances.

Cost of the problemNurses back injuries cost an estimated $16 billion

annually in workers compensation benefits. Medical treatment, lost workdays, “light duty” and employee turnover cost the industry an additional $10 billion.iii

Bureau of Labor Statistics show an inexcusable situation. Fig. 1 is a 2007 Bureau of Labor Statistics chart of the industries with the highest numbers of worker injuries.iv The top category: hospitals. In addition, the fourth and fifth categories are also of health care workers. In total, over 505,000 health care workers were injured. We know that a large percentage of these injuries are due to patient handling.

Fig. 1v

It is interesting that the Bureau of Labor Statistics divided health care into three categories, when they are really of one industry. A more accurate chart would look like Fig. 2:

Fig. 2

Healthcare worker injuries were three times the number of any other industry. Also, the RATES of injury are six times the rates of construction workers and dock workers. Why are we not angry? Perhaps it is because we are used to it, and figure that it can’t be any other way. After all, patients must be cared for, right?

THE CAUSES OF NURSING BACK INJURY, or, YOU MUST NOT BE USING GOOD BODY MECHANICS

Hospitals and nursing homes are well aware of the risks of back injury resulting from patient care. Virtually all of us have had numerous “back injury prevention” classes over our work life. Why then, are the injuries so high? Is it because we just don’t listen? Or, is it because there is no safe way to manually lift and care for patients? Just look at the diagram above for a comparison between the NIOSH lifting standards and everyday patient care reality.

Continued on VSNA Website www.vsna-inc.org

General Medical and Surgical HospitalsGeneral Merchandise Stores

Administrative & Support ServicesAmbulatory Health care services

Nursing Care facilitiesTransportation equipment manufacturing

Merchant wholesalers, durable goodsLimited-service eating places

Fabricated metal product manufacturingBuilding equipment contractors

Supermarkets & other grocery storesFull-service restaurants

Food manufacturingMerchant wholesalers, nondurable goods

ANA/VSNA News Specialty Organizations

Submitted by Irene Bonin and Elizabeth Hansen

Ten percent of the U.S. population is estimated to have a substance use disorder. Nurses are no exception. Misuse of substances may involve illegal or illegally obtained drugs, prescription drugs, alcohol, or a combination of these categories. The Vermont State Board of Nursing accepts the premise that substance use disorder (DSM-IV) is an illness and should be treated as such. Nationally, the majority of state boards of nursing have recognized the need to offer nurses a voluntary, non-public alternative to discipline that will support their licensees in recovery and allow them to continue practicing professionally as long as they comply with program requirements.

Since 2004, the Vermont State Board of Nursing has offered the Alternative Program for eligible nurses and nursing assistants. The first participants enrolled in 2005 and to date, a total of twenty RNs, LPNs, and LNAs have been accepted into the program. Three licensees have successfully completed their three-year contracts and four people are currently participating. Of those who did not complete the Alternative Program, some allowed their licenses to go on inactive status. Others failed to comply with the terms of their contracts and were referred for disciplinary action. Given the enormous impact of substance use disorders on society in general, and on nurses in particular, it is expected that many more Vermont nurses and nursing assistants are eligible for and would benefit from participation in the Alternative Program.

Referrals for the program come from a variety of sources: self-referral, employer or Employee Assistance Program referral, in-patient and out-patient treatment

providers, primary care providers, concerned family and friends, and Board of Nursing staff upon review of licensure applications. Prior to acceptance to the Alternative Program, the prospective participant needs to submit an Independent Evaluation by a professional who is educated, experienced, and credentialed in substance use issues. Once accepted into the program, the licensee is required to follow the terms of the contract which include monthly employer and counselor reports, random specimen testing, and documented participation in recovery groups. While participation in the program and details of the contract are non-public, information may be shared with the employer to ensure adequate work site monitoring and compliance, as well as public safety.

In its goals for 2010, the Vermont State Board of Nursing recognized the importance of reviewing the current Alternative Program. A team has been convened to consider best practices from other states and evidence-based information that might be incorporated into the Vermont Alternative Program. Recently, two members of the team attended the Substance Use Disorders Forum held by the National Council of State Boards of Nursing (NCSBN) in Chicago. They returned with valuable information on national trends. Model guidelines for alternative programs will be released soon by NCSBN.

A key measure of success for Vermont’s Alternative Program for nurses and nursing assistants will be an increase in referrals and participants in the program. The Board of Nursing and the Alternative Program team identified the development of a new brochure as a priority and this goal has been accomplished. Additionally, marketing the program to licensees, other professionals and employers, and the public is underway.

Substance use disorder is a disease that can be diagnosed and treated. Similar to other chronic illnesses, those diagnosed must accept responsibility for its management. Eligible nursing professionals can voluntarily enter the Alternative Program to help sustain their recovery. Participation in alternative programs has been shown to greatly reduce the risk of relapse. The Alternative Program might be just what a nurse needs to help get his or her life—and career—back on track!

The new brochure is posted on the Board of Nursing website: www.vtprofessionals.org/opr1/nurses. To order a supply of brochures or for more information about the Alternative Program, a confidential call can be made to 802-828-2819.

Vermont State Board of Nursing’s Alternative Program: A Road Back

District to District Membership CompetitionThe competition is on!! This is an initiative to recruit

new nurses and to stimulate our members. The goal of this competition is to strengthen and build our membership. The prize will be free registration for 2010 Convention in Colchester. In addition, VSNA member, Richard Frank’s company, Frank and Associates, will donate one night’s stay at the Hampton Inn including meals. The prize will be awarded to the District with the greatest percent increase in new membership from December 2009 to September 2010. The winning district will be able to raffle off the prize to their members prior to Convention and the winning member will be announced at the Convention. So start doing your part by speaking to colleagues about joining!!

Another initiative is the “Ask Me About VSNA” button campaign. Please wear the Ask Me About VSNA button the week of August 23rd. Speak to colleagues and friends about all the great reasons to join.

August, September, October 2010 Vermont Nurse Connection • Page 11

SUPPORTERS

♦ Fletcher Allen~ Nursing Education & Research~ James M. Jeffords Institute for

Quality & Operational Effectiveness

♦ Sigma Theta Tau Honor Society~ Kappa Tau Chapter~ Gamma Delta Chapters

♦ Southwestern Vermont Medical Center♦ University of Vermont Department of

Nursing♦ Vermont State Nurses Association

Foundation♦ Visiting Nurses Association of Chittenden

and Grand Isle Counties