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Volume 26 • Number 2

May, June, July 2017

UTAH NURSEMany Roles. One Profession.

www.utnurse.org

Utah Nursing Consortium

Page 4

Nurses’ Day at the

Legislature

Pages 8-9

Nurses on the National Front

Page 10

Co

nte

nt

Inside

The Official Publication of the Utah Nurses Association

Quarterly publication direct mailed to approximately 33,000 RNs and LPNs in Utah.

PRESIdENT’S MESSAgE

Attention UNA Members

You can now find us on Facebook. Just search Utah Nurses Association and look for the page with the

UNA logo. We will be posting updates for upcoming events and information on conventions in our blog.

Aimee McLean

1 President’s Message2 Utah Nurses Association Seeks Board Members3 From the Editor3 GRC Committee News4 Utah Nursing Consortium4 Nurses on Boards Coalition5 A Day in the Life of a Clinical Investigator6 A New Look at Sepsis

8 Nurses’ Day at the Utah State Legislature 201710 Nurses on the National Front11 From the Membership Committee12 In Memoriam12 Utah Enacts Enhanced Nurse Licensure Compact (eNLC)13 Utah Nurses Foundation14 Get Smart15 A Patient’s Journey: Fracture

SAVET H E

DAtE

The Utah Nurses Association Annual Conference and Annual Advocacy Preparation Conference will be October 12th & 13th, 2017. Legislators, in addition to

healthcare policy experts attend to speak, teach and advise regarding healthcare issues of vital concern to nurses in

Utah and across the nation. This is your opportunity to learn how to make your voice heard as a leader in healthcare.

Spring is here and while you are all spring cleaning and planting, we here at UNA are doing the same. We are working to revamp our website and to plant the seeds to grow our membership! We have launched a new recruiting program and in conjunction are working to expand our member benefits. We will continue to do our statewide work representing the best interests of all nurses in Utah but we are also working to grow our member’s only benefits. Check out our website for updates on new features. Very soon, if not already, members will be able to access members only sections of our website where they can engage in various ways with other members. If you have a passion or preference, please let us know and we can work to incorporate your desires as we grow! Healthcare in the US is facing some

major changes and we know that nurses are at the heart of it all. Let us know what you think and how you feel. Send us an email, contact us on Facebook, follow us on Twitter, send a letter to the editor… however you prefer, reach out to us! Let us know what you love, like, hate, fear, and are passionate about in healthcare. Spring brings renewed energy and enthusiasm. We welcome you all to reach out and get involved!

Celebratingnational

nurses WeekMay 6-12, 2017

Utah Nurse • Page 2 May, June, July 2017

INTERNET NURSING

UTAH NURSES ASSOCIATION receives

its Internet services due to a generous grant from XMission, Utah’s largest and best local

Internet Service Provider. For more information on XMission’s services and pricing visit XMission on the Web at www.xmission.com or call 801-539-

0852.

Please visit the Utah Nurses Association’s Web Page!

utnurse.org

Visit our site regularly for the most current updates and information on UNA activities. You can

obtain a listing of Continuing Education Modules available through UNA or a listing of seminars and

conferences that offer CE credits.

2017 BOARD OF DIRECTORSPresident Aimee McLean, BSN, RN, CCHPFirst Vice President Donner Schweitzer, BSN, RNSecond Vice President Claire LeAnn Schupbach, BSN, RN, CPC, CHPSecretary Open - If interested please email resume to UNATreasurer Tracy Schaffer, MSN, RNDirectors Sharon K. Dingman, DNP, RN Blaine Winters, DNP, ACNP-BC

STAFF MEMBERSOffice Manager Lisa TrimOffice Assistant Kaitlin McLeanLobbyist Justin StewartEditor Claire LeAnn Schupbach, BSN, RN, CPC, CHP

COMMITTEECHAIRS & LIAISONSBy-Laws Open - If interested please email resume to UNA Finance Tracy Schaffer, MSN, RNGovernment Relations CJ Ewell, MS, APRN-BC and Diane Forster Burke, MS, RN Kathleen Kaufmann, MS, RN, BCMembership Sharon K. Dingman, DNP, RN Nominating Monte Roberts DNP, RN Janelle Macintosh, PhD, RN Lauren Clark, RN, PhD

UTAH NURSES FOUNDATIONPresident Marianne Craven, PhD, RN Aimee McLean, BSN, RN, CCHP

ANA MEMBERSHIPASSEMBLY REPRESENTATIVESAimee McLean, BSN, RN, CCHPBarbara Wilson, PhD, RNC

PRODUCTIONPublisher Arthur L. Davis Publishing Agency, Inc.

Editor and Publisher are not responsible nor liable for editorial or news content.

Utah Nurse is published four times a year, February, May, August, November, for the Utah Nurses Association, a constituent member of the American Nurses Association. Utah Nurse provides a forum for members to express their opinions. Views expressed are the responsibility of the authors and are not necessarily those of the members of the UNA.

Articles and letters for publication are welcomed by the editorial committee. UNA Editorial Committee reserves the right to accept of reject articles, advertisements, editorials, and letters for the Utah Nurse. The editorial committee reserves the right to edit articles, editorials, and letters.

Address editorial comments and inquiries to the following address: Utah Nurses Association, Attn: Editorial Committee 4505 S. Wasatch Blvd., Suite 330B Salt Lake City, UT 84124 una@xmission.com, 801-272-4510

No parts of this publication may be reproduced without permission.

Subscription to Utah Nurse is included with membership to the Utah Nurses Association. Complementary copies are sent to all registered nurses in Utah. Subscriptions available to non-nurse or nurses outside Utah for $25. Circulation 27,000.

All address changes should be directed to DOPL at (801) 530-6628.

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. UNA 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 Utah 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. UNA 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 UNA or those of the national or local associations.

Published by:Arthur L. Davis

Publishing Agency, Inc.

utnurse.org

The Utah Nurse Publication Schedule for 2017

Issue Material Due to UNA OfficeAugust/September/October 2017 June 9, 2017

Guidelines for Article DevelopmentThe UNA welcomes articles for publication. There is no payment for articles published in the Utah Nurse.1. Articles should be Microsoft Word using a 12 point

font.2. Article length should not exceed five (5) pages

8 x 113. All references should be cited at the end of the

article.4. Articles (if possible) should be submitted

electronically.

Submissions should be sent to: una@xmission.com orAttn: Editorial Committee | Utah Nurses Association

4505 S. Wasatch Blvd., Suite 330BSalt Lake City, UT 84124 | Phone: 801-272-4510

PUBLICATION

Are you interested in advocating for nurses in Utah? Want to get involved but are not sure how? Here is your opportunity!!

The Utah Nurses Association is seeking to fill three board positions with elections held in October. We are seeking a diverse candidate pool for the offices of President-Elect, 2nd Vice President, and Secretary. This is a great opportunity to serve the nursing profession, and have your voice heard. Elected Officers will serve a two-year term, except for the President-Elect who will serve three years, one year as President-Elect, and two years as President beginning in January 2018, attend all meetings unless excused. Summaries of the Office responsibilities are listed below. More information and applications are available by contacting Lisa Trim, Office Manager of the Utah Nurses Association at 801 272-4150. The deadline for nominees to submit their applications will be September 3, 2017.

PRESIDENT-ELECT1. Shall be a member of the House of Delegates

and the Board of Directors, and shall attend all scheduled meetings.

2. Shall automatically succeed the President in the event that the President is unable to fulfill the elected term of office.

3. Shall serve as a resource person to the Conference Committees

4. Shall accept assignment from the President5. Shall serve as a liaison to the Nominating

Committee

SECOND VICE PRESIDENT1. Shall be a member of the House of Delegates

and the Board of Directors, and shall attend all scheduled meetings.

2. Editor of the Utah Nurse quarterly paper unless another editor is appointed.

3. Shall accept assignment from the President.4. Shall serve as a liaison to the Utah Nurses

Foundation.5. Shall serve as a liaison to the Membership

Committee.

SECRETARY1. Shall be a member of the House of Delegates

and the Board of Directors, and shall attend all scheduled meetings.

2. Shall assure the minutes are taken at each meeting and distributed to all members of the House of Delegates and Board of Directors. Review minutes prior to distribution.

3. Shall maintain the office record of term of office for officers and committee chairs of the organization. This shall be recorded annually in the Board of Directors minutes.

4. Shall accept assignment from the President.5. Shall serve as a liaison to the Nominating

Committee.

Utah Nurses Association Seeks Board Members

Get credit for your education efforts!

There are as many aspects to nursing practice as there are settings and types of nursing practice. The “needs” that are identified

for professional development and practice enhancement will be as varied.

Don’t assume you can’t offer CE – Utah Nurses Association can help.

• Contacteducation@westernmsd.org with questions.

• Visitwww.utnurse.org/Education to view FAQs and application information.

May, June, July 2017 Utah Nurse • Page 3

FROM THE EdITOR

Claire L. Schupbach

Time has moved at warp speed this year for our organization and for the nursing practice, so much has happened already. Regardless of political preference, I think we can all agree that we have witnessed a profound re-engagement in the political arena and conversation, both in Utah and nationally. Nurses’ day at the Utah Capitol was no different, we had more legislators willing to discuss, share and face the hard questions than time allowed. The participation from you all was dynamic and passionate, it was a true honor to be present. The UNA was directly asked if all views are desired and printed from the Utah nursing community. My answer today, is the same as that day ~ We are here to represent the entire Utah nursing community. We covet more conversation, engagement and collaboration. In keeping with the Healthy Nurse Healthy Nation ANA theme for 2017, we have a Nutritionist that has graciously provided expert nutritional insight. Important to all nurses in Utah is the update regarding the Interstate Compact. This is

of interest to those of you who currently or wish to practice in telehealth. A particularly proud moment for the state of Utah nursing community, is the University of Utah’s Founder’s Day Award Ceremony and dinner. Pam Cipriano, president of the ANA was honored along with a new RN, whom has overcome personal challenges. In honor of National Nurses’ Week we wrapped up this edition with turning our attention to matters that directly address the heart of nursing. A brave patient willingly shared their journey from health, to catastrophic injury to wellness. Finally, along the way, in interviewing for A Day in the Life of a Clinical Investigator, we found the love and influence of a grandmother, both in the history of the state and of her granddaughter.

gRC COMMITTEE NEWS

Kathleen Kaufman MS, RN, GRC Co-Chair

If you want a brief summary on a health care or nursing related bill, one good place to check is the UNA website at www.utnurse.org. Under the legislative tab on the left of the home page is the bill tracker. Bills appear on this page as the Government Relations Committee (GRC) discusses and comes to a position on each bill under consideration. The number of bills grows as the GRC and BOD members come to some consensus on each bill. Usually we do not list bills on which we have not come to a position, but there are exceptions to this. A final bill tracker is posted after the Governor has signed the bills into law so that you can be aware of the ultimate outcome of each piece of legislation.

This year a total of four bill tracker updates were published – ending with a total of 22 bills posted. Approximately 10 bills remained that we considered and either did not reach consensus or did not have adequate input to take a position. IF YOU are passionate about an existing bill, we will try to evaluate it if possible. The best way you can help to get bills noticed and evaluated is to join UNA and become a member of the GRC to help do the work! A total of 27 people were involved in reviewing bills this year, but we welcome others to join. The participation of all GRC and BOD members is deeply appreciated by the co-chairs of this committee, Diane Forster-Burke, CJ Ewell, and Kathleen Kaufman.

Depending on the probable impact of a bill, members of the GRC also will go to the assigned standing committees of each legislative body and testify on the bill. We may send formal letters of support or of helpful content input from the UNA to sponsoring legislators or to the entire committee. We monitor all bills at least superficially that appear before both the House and Senate Health and Human Services (HHS) Committees. We are gradually building relationships with members of these committees, which lends credibility to our comments when we make them. While

the HHS committees are well-versed regarding health issues, other committees may need more information or education if a complex or crucial bill goes to their committee. Your GRC members strive to present UNA’s position in person, by email or by phone contacts. YOU can join us and learn how to influence legislation. (We do continue this work during the rest of the year, or the “interim,” following key health issues on the hill. We would be happy to take you along to see how the real work gets done.)

We members of your BOD and the GRC take our mission of advocacy and education for nurses and the public very seriously. We support legislation that enhances the work of specialty nursing groups whenever possible. This year we have worked with the Utah School Nurse Association, the Utah Nurse Practitioners, the CRNAs, and mental health nurse practitioners. Join us to help make a difference in your world.

GRC Committee News & a Review of the Bill Tracker

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Utah Nurse • Page 4 May, June, July 2017

ANA Launches Inaugural New RN’s

Webinar SeriesThis year ANA will be launching our first ever

New RNs Webinar Series. The webinars are free and focused on relevant topics for new nurses. The first year as an RN is critical and we want to make sure new nurses are ready and prepared to thrive. This is a great opportunity to cross-promote the series with members and non-members in your state to ensure they are ready for success as they navigate through their career. The webinar series is a great engagement strategy for members and lead generation opportunity for non-members.

 Upcoming Webinars:

• How to Bounce Back After Challenges at the Bedside

Wednesday, April 26, 2017, 12:00 PM EDT

• HowtoProtectYourRNLicense Wednesday, June 07, 2017, 12:00 PM EDT

UTAH NURSINg CONSORTIUMTeresa Garrett, DNP, RN, APHN-BC

Project Director, Utah Nursing ConsortiumRebecca Walsh

Plenty of Utahns want to be nurses. That’s never been a problem.

The state’s eight public nursing schools turned away 900 applicants last year — not because they weren’t qualified for the rigors of nursing school, but because there aren’t enough faculty members to teach them.

Meanwhile, Utah hospitals, clinics and nursing homes had more than 1,200 vacant nursing jobs they couldn’t fill in 2016.

“We are a workforce shortage for the state of Utah,” University of Utah College of Nursing Dean Trish Morton told members of the Utah Legislature’s Higher Education Appropriations Committee in February.

The paradox — between the growing demand for nurses and the inability of colleges and universities to educate them — has been building for years. While nationwide, the nursing shortage is expected to reach 1 million by 2020, Utah’s nursing shortage is unique: the state has one of the highest birth rates in the country combined with a rapidly aging population that lives longer than average. All three trends are increasing pressure on the state’s healthcare systems.

“This nursing shortage is different than those we have experienced in the past,” said Susan Thornock, chair of Weber State University’s School of Nursing. “It started out slowly, but we have seen it become more and more urgent as the lack of nurses, to fill bedside positions, has increased. It has the potential to become one of the most dire shortages we have seen in years.”

In an effort to close the gap, the state’s eight publicly funded nursing schools and private schools at Brigham

Young University and Westminster College banded together to form the Utah Nursing Consortium and lobby state lawmakers to provide more funding for nursing faculty.

“We are very concerned about this nursing shortage — for the state of Utah and for our citizens. We want to be proactive in solving this problem for our state,” Morton said.

The New York-based Jonas Foundation estimates that one nursing instructor over a 30-year career will impact the lives of 3.6 million patients his or her students eventually will care for.

Educating highly-trained nurses is particularly expensive — about $7,500 per student each semester. Unlike business, social science or even art history programs, nursing colleges can’t fill auditoriums with 200 students to teach them critical life-saving skills all at once. The ratio of instructors to students during nursing clinical training is much smaller: one to eight. An eight-student cohort preparing to become registered nurses requires nearly the same number of instructors over the course of their education — one specialized in maternal-child care, another in psych/mental health, another in gerontology, etc. At the same time, those nursing students must complete hundreds of precious hours in a clinical setting before they can graduate.

Utah Nursing Consortium organizers based their lobbying group on a long-term campaign to meet the demands of tech companies clamoring for more engineering graduates. In 2001, state lawmakers established the State Engineering and Computer Science Initiative with the support of then-Gov. Michael Leavitt and University of Utah President David Pershing, who was Dean of the College of Engineering at the time. Over the past 15 years, the state has provided $10 million in annual funding to the engineering schools and more than $15

million in additional one-time support.

Using a $50,000 seed grant from the Dr. Ezekiel and Edna Wattis Dumke Foundation, nursing school administrators met over the summer to strategize and hone their message. In the end, the nursing schools asked for $2.6 million during the 2017 Legislature, pledging to prepare 100 new registered nurses.

While the schools’ request received priority consideration, lawmakers ultimately did not fund it. It’s unusual for nonprofit groups to receive funding the first time they ask. Utah Nursing Consortium Director Teresa Garrett says this was a building year. “It’s a chance to lay the groundwork, to talk to legislators and to establish a framework,” she said.

Marilyn Davies, senior development director for the College of Engineering, says Utah’s nursing schools should not be discouraged. “This is not a one-year effort. It takes many years,” Davies said. “Success depends on a multitude of factors—primarily the budget forecast, the availability of new funds, and competing needs.

“It may take additional sessions, the time spent this year in educating legislators has been worthwhile and will help lay the groundwork for future efforts.”

Morton explained to lawmakers, with a warning, what’s at stake: “All of you will need a nurse at some point in your life,” she said. “We hope when you wake up from surgery in pain, there will be a nurse there to help you.”

Legislators on the appropriations committee laughed nervously. “Nurses are very important,” said Rep. Keith Grover, R-Provo, the committee co-chairman.

Representative Derrin Owens and

Teresa Garrett

In 2010, the Institute of Medicine released a landmark report, The Future of Nursing: Leading Change, Advancing Health, which recommended increasing the number of nurse leaders in pivotal decision-making roles on boards and commissions that work to improve the health of everyone in America. The Nurses on Boards Coalition (NOBC) was created in response to this, as a way to help recruit and engage nurses to step into leadership roles.

The NOBC represents nursing and other organizations working to build healthier communities in America by increasing nurses’ presence on corporate, health-related, and other boards, panels, and commissions. The coalition’s goal is to help ensure that at least 10,000 nurses are on boards by 2020, as well as raise awareness that all boards would benefit from the unique perspective of nurses to achieve the goals of improved health in the United States.

We encourage each and every one of you, over 3 million strong, to visit www.nursesonboardscoalition.org, sign up to be counted if you are on a board and read more about the efforts being made to help build the future of our profession.

May, June, July 2017 Utah Nurse • Page 5

A Day in the Life of a Clinical Investigator

Deon Gines, PhD, Human Nutrition

Your food choices are the most important health decisions that you make every day. Eating right just makes you feel better—after all, you are what you eat. As a nurse, you see the devastating effects of bad food choices every day. As a spouse or parent, you create your family health habits.

There’s been lots of nutrition research and what we know has changed and improved recommendations. And then there’s also lots of bad nutrition info and advice in the media. So what’s best? Here is the basis of a delicious and healthy food intake.

Variety: Go for 10. Choose more kinds of foods at each meal. Foods have thousands of nutrients, and each one has a unique blend. (Check your vitamin/mineral supplement—most have only 10-20 nutrients. They’ll never replace a varied plate.) I don’t mean have 10 servings! Consider these meals:

Rolled oats with milk, and spoonfuls of dried berries, raisins, unsweetened coconut, sunflower seeds and almonds. Add a slice of toast with peanut butter.

Sandwich with wheat bread, 2 oz meat and cheese, and lots of lettuce or cabbage, slice of onion, tomato, peppers. Add a side of carrot and celery sticks for crunch (instead of chips). Drink water.

Pasta made with sauce made with tomato paste, onion, black beans, zucchini, diced tomatoes, sliced mushrooms, and spinach. Add a side green salad.

Get the kids involved: Who can count to ten? If the plate is a bit short—raid the refrigerator! Quarter an orange, grate some cheese, sprinkle cranberries on the salad.

Balance: Include choices from all the food groups (meats/proteins, dairy, grains, fruit and vegetables)

Meats, eggs, dried beans and peas, nuts: Dried beans are high in protein, fiber, and B vitamins, and have no fat or salt. Make a crockpot of beans. Freeze in small packages. Then add their protein and flavor for tacos, quesadillas, salads, pastas, baked potatoes, no limit to the options.

Milk, yogurt, cheese: Every human civilization has used milk as a source of protein and calcium (among other nutrients). We are learning more about the value of fermented foods like yogurt and cheese. Homemade yogurt is healthy, inexpensive, easy (with a bit of practice), delicious, and can be eaten with fruit, used for topping baked potatoes, to make salad dressings, etc.

Grains have been at least half of the human diet for thousands of years. Keep a variety on hand including wheat, corn, rice, oats. Grains provide lots of vitamins and minerals, fiber, and the best source of energy. Make a yeast “starter” and add another fermented food and fun project for the whole family.

Fruits and vegetables: Try something new every time you go shopping. Buying fresh in season means extra variety, more nutrition and a lower price. Buy only as much as you can use, and prep it before you store it. Kids are much more likely to eat pineapple or celery if it’s already cut. Avoid fruit juices—they are high in sugar and don’t have the filling fiber and other pulp nutrients of whole fruit.

Fats are part of a healthy diet, and an essential nutrient. The same principles apply: use in moderation, fats are the most concentrated source of calories: 1 tsp=45 calories; small apple=45 calories. Choose a variety of kinds including butter, olive oil, canola oil. Avoid margarine, shortening, and other saturated fats.

Moderation: Worldwide people are eating more and doing less, and obesity has become a major health concern. Rates of obesity, diabetes, and heart disease are going up among children. Gradually reduce sizes of servings of meats/entrees (1/4 of your plate or the size of the palm of your hand), gravies, dressings, sauces (measure 1 tablespoon a few times to get a sense of how much/little that is), toward healthy serving sizes. Increase sizes of servings of vegetables and grains to ¾ of the plate.

Here’s another important 10—the first 10 lbs of weight loss is the most important. Attain and maintain a healthy weight, BMI of 30 or less. Check your BMI here: https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

Real: Eat food that is as close to how it comes from nature, field or tree as possible. Canned and frozen fruits and vegetables are OK, but avoid processed foods that have added sauces, salt, sugars, flavor packets. Look for the real food in this name brand pulled pork ingredient list (how many times do salt and sugar appear?) Consider prepping your own pulled pork in a crock pot!

INGREDIENTSPork, bbq sauce [water, sugar,

tomato paste, distilled vinegar, pineapple juice concentrate, modified food starch, worcestershire sauce (distilled vinegar, molasses, corn syrup, water, salt, caramel color, garlic

powder, sugar, spices, tamarind, natural flavor), sea salt, tamarind

extract, natural hickory smoke flavor, natural flavor, sodium benzoate and

potassium sorbate (preservatives), spices, ground paprika, garlic powder],

water, contains certain 2% or less: salt, sodium phosphate, sugar, natural hickory

smoke flavor, pork flavor (pork stock salt), spice, flavorings, paprika, yeast extract, dextrose.Look online or register for a local community garden

workshop. Plant a tomato in a pot on your patio, or try a square food garden in a small space. Check the list of farmer’s markets and take a family field trip.

Choosemyplate.gov is a reliable, non-commercial source of information about healthy eating, sizes of servings, calories, weight loss, etc.

What to drink? Water is a perfect choice, readily available, free. Avoid any drinks that contain calories, sugar. Make a pledge to reuse your water bottle and refuse to use plastic!

What about salt and sugar? You don’t need to add any salt or sugar to get a healthy diet: Less is more. Excess salt and sugar is linked with heart disease, obesity, and diabetes. Added salt and sugar is all about habits. Cut back a little at a time, and retrain taste buds. Avoid adding salt or sugar to your children’s food.

Read about how the sugar industry pushed researchers and public awareness of food and heart disease toward fats (and away from sugars.) http://www.huffingtonpost.com/entry/sugar-harvard-scandal-nutrition-study_us_57d8088ee4b0aa4b722c6417

Deon Gines has a PhD in Human Nutrition from Michigan State University, and has worked in academic and clinical settings for decades. Her most recent position was 10 years as Clinical Nutrition Manager at Salt Lake Regional Medical Center. She is transitioning to retirement, but staying busy teaching nutrition in the nursing school at Westminster College, and working PRN for Intermountain Medical Center dialysis department.

How to Add 10 Healthy Years to Your Life!

Jennifer Steffee, RN, BSN, CPC, CPMA, AHFIAs told to Claire L Schupbach

The first question I usually get is how did I get in this field of practice? Why would I move from direct patient care to a seemingly ‘dry and dull’ practice? “Burnout” is my answer. A few years in pediatric oncology took a toll, as I lived through the loss of many patients. I found myself looking for a break and found myself in Revenue Integrity at IHC.

In the normal course of conversation, I typically do not find many nurses that are aware of RN’s practicing as clinical investigators. Although this area of practice has been around for some time, it is new to nursing and is not currently recognized in nursing surveys, etc. The course of a day varies with the type of investigation I am currently conducting. The most familiar type of clinical investigation is a Medical Chart Review, which is a desk review of medical records for fraud, waste and abuse. Defining these industry terms is helpful to the conversation. Fraud, includes an element of intent, typically billing for services never rendered and is proven in a court of law. Waste and abuse, can have a range of definitions; however, waste is typically defensive medical practice and abuse can include upcoding and unbundling.

Medical Chart Reviews can be conducted as a desk audit or on-site at a facility as part of a pre-pay or post-pay audit or review. Most specific to clinical investigations, is a review, as audits can be typically associated with hospital bills and validation of DRG assignments. The defining criterion can be one of

several actions, including: patient reporting to the payer, a whistleblower, or analytics/software that shows an abnormal pattern of billing for a provider.

I have also worked as part of full field investigation teams, where we went on-site to a doctor’s office. Not only did we pull records and review, we verified that all the special equipment needed to support the services being billed were present at the doctor’s office. Clinical investigators can also help with direct patient interviews/investigations in conjunction with law enforcement. I have worked in a Utah healthcare company on a team with former F.B.I. and other law enforcement officials on behalf of both government and commercial payers.

Clinical expertise is what sets an RN apart from the other non-clinical investigative team members in this field. A nurse with patient care experience can assess for treatments that are not typically appropriate given a patient’s medical history. I can also review for quality of care issues, that a medical coder or law enforcement investigator misses. Part of my tenure in Utah, has been to provide education to doctors and their staff regarding why their billing, coding and documentation is not meeting industry regulations and guidelines. I practiced in this role for a Utah company responsible for managing the benefits of public employees.

Practicing within my scope is still an absolute. As a reviewer, investigator or interviewer I report what was in the medical records, the appropriate regulations and coding rules, the standard of quality of care and the variance from the standard deviation; however, the final decision as to medical necessity and reimbursement is made by providers/doctors, law enforcement or the

payer. (as appropriate).Like most clinical investigators, I didn’t start

my nursing practice with an awareness of clinical investigating nor a desire. The path to my nursing career, started at age 6 or 7, when my grandmother would take me on her rounds. She was a public health RN, who worked in rural Utah and continued to complete welfare checks even after retiring. Due to her gift of including me in her life, personally and professionally, I started working in nursing while in high school. As a clinical investigator, I promote patient advocacy through ensuring healthcare dollars are not wasted or stolen. That improper or unneeded medical care is discovered and corrected. That providers are reimbursed properly for the care they provide. I educate and support my colleagues on proper documentation and industry regulations.

Notes by Claire L SchupbachThe path of this interview, perfectly reflected Jennifer’s

area of practice, in that, we started down the path of an informational/educational exercise and found the real story. Yes, we discussed at length the nursing practice of a clinical investigator; however, the impact of her grandmother on her life was the actual story. In her daily work life, she starts with a claim, a set of medical records and as she listens and hears, the true story materializes. To all of us that are parents, mentors, aunts, uncles this is a timely message with Mothers’ & Fathers’ Day and graduations around the corner. Presence is unparalleled and cannot be imitated. A Utah, rural, public health nurse that took her grandchild with her on rounds at the age of 6 is impacting the health of our state today.

The Real Story ~ A Grandmother’s Presence ~

Utah Nurse • Page 6 May, June, July 2017

A NEW LOOk AT SEPSIS

Evy Warmbier, RN

Ms. Warmbier worked at Holy Cross Hospital in Salt Lake City for 20 years, primarily in acute care and specialty areas, the ICU, the cardiac cath lab and the operating room. Her strong interest has been caring for cardiovascular cases. She later moved to Florida, earned her Masters of Nursing and joined the faculty of Broward College, coordinating and lecturing for the Critical Care Nursing program. She has recently moved back to Utah and formed UT Nurse Educator, LLC.

As of 2012, the American Hospital Association and the Health Research & Education Trust reported that Sepsis treatment resulted in an estimated total cost of $20 billion for all hospitalizations, which was the highest single condition hospital cost for all payers. Patients with Sepsis and Septic Shock are estimated to have a mortality rate of 28 to 50%. Also, four different studies show a marked increase in the incidence and mortality of Sepsis from 2004 to 2009.

The purpose of this article is: (1) to review the February 2016 updated sepsis definitions and clinical criteria, (2) to provide new directions for early identification outside the ICU and review issues within the ICU, (3) to present emergent sepsis interventions, treatments and post sepsis healthcare issues, (4) and to introduce references and associations that can assist in patient teaching and update sepsis protocols for your facilities.

The first defining sepsis conference was held in 1991, with some updates at a second conference in 2001. However, for more than two decades the definition of sepsis, septic shock and organ dysfunction remained largely unchanged. When healthcare practitioners identified two or more Systemic Inflammatory Response Syndrome (SIRS) criteria (Temperature >38°C or <36°C, Heart rate >90/min, Respiratory rate >20/min or PaCO2 <32 mm Hg, and/or White blood cell count >12,000/mm3 or <4000/mm3 or >10% immature bands), there was a suspicion of infection. SIRS with a presumed infection was called Sepsis. Sepsis with ≥1 sign of organ dysfunction was called Severe Sepsis, and Septic Shock

was defined when there was refractory hypotension when the patient did not respond to fluid challenges, and vasopressors and inatropes were initiated.

Problems occurred because these original definitions were SIRS based. Since SIRS is a normal body response to any inflammatory event, SIRS is not a useful defining criteria. There was a need for updated definitions and screening tools.

As reported in JAMA, February 23, 2016, a task force (n+19) was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine, which included experts in sepsis pathobiology, clinical trials, and epidemiology. The resulting third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), now define sepsis as life-threatening organ dysfunction caused by dysregulated host response to infection. And Septic Shock is a subset of Sepsis where profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. SIRS and severe sepsis are removed from the definitions.

The American Association of Critical-Care Nurses (AACN) says that definitions should be able to be measured clinically, be easily obtainable in all settings, provide conformity, and reflect current understanding of sepsis physiology. The new sepsis task force tools recommended for early identification and screening of sepsis, qSOFA and SOFA, meet these criteria.

SOFA stands for Sequential (Sepsis-Related) Organ Failure Assessment. On non-ICU nursing units, qSOFA criteria should be used, where q stands for quick. The three qSOFA measurements are Hypotension with BP <100 mg Hg, Altered mental status with a Glasgow Coma Scale of less than 15, and Tachypnea with a respiratory rate of ≥ 22/min, often referred to as HAT. Several hospitals have established qSOFA review for every patient, every shift, every day. If two of the three criteria can be identified, there is a suspicion of Sepsis, which means that these patients with suspected or presumed infection, are highly likely to have poor outcomes and the practitioner must then move to the SOFA scale.

The sequential organ failure assessment or SOFA scale reflects organ dysfunction with scoring that quantifies abnormalities by six organ systems and accounts for clinical interventions. They are: Respiratory, Coagulation, Liver, Cardiovascular, Central Nervous System and Renal. While generally it is determined that a patient will be transferred to a higher level of care such as an ICU when the diagnosis of sepsis is confirmed, when an ICU bed is not available, many of the lab tests and interventions can also be done on a nursing unit or an emergency department. • Respiratory measures the PaO2/FiO2 ratio. To review,

the SpO2 or pulse ox measures the percent of oxygen molecules attached to hemoglobin. There are 4 available attachment sites, and this oxygen is carried through the circulatory system. It is measured in % and the measurement is pulse driven. According to the AHA, ideal is 95%.

Cellular oxygen demand and acid-base balance determines how easily these oxygen molecules are released into serum and then available to the cells. It then becomes the PaO2 and is measured in mm Hg. Normal is 80 to 100 mmHg, but is often seen as low

as 60 mmHg. This value is obtained from an arterial stick. Only about 2 to 3% of total oxygen is in serum.

The FiO2 is the fraction of inspired oxygen. Charts are available to assist in this calculation, but room air at sea level has FiO2 about 21%. In Salt Lake City with the elevation at 4,000 to 5,000 feet, room-air FiO2 is about 18%. A patient with nasal oxygen at 6 L/min receives FiO2 about 45%. Non-rebreathers can deliver 80 to 100% depending on the mask vents. The ratio calculation with a PaO2 of 65 divided by FiO2 at 45% is 65/.45 = 144 which is in a very dangerous number with a SOFA score of 3. This patient may need mechanical ventilation. The normal ratio is 400.

• Coagulation organ dysfunction is measured by the platelet count. Normal is about 150,000 to 400,000. As the platelet count goes down, (thrombocytopenia) the SOFA score goes up. A sign of low platelets may be minimal, or petechiae on arms and legs to severe bleeding.

• Liver organ dysfunction is measured by Bilirubin in mg/DL. This is the breakdown of red cells. Normal is <1.2. The higher the number, the higher the SOFA scores. These patients can often be identified with scleral and/or general jaundice. The test requires a small blood draw.

• Cardiovascular organ dysfunction is primarily concerned with hypotension and is often measured by the mean arterial pressure (MAP). This can be obtained from the monitored arterial line or cuff pressure. However, it can also be calculated,

(2 diastolic BP + Systolic BP) / 3. Normal is 70 to 110 mmHg. Less than 70 gives a SOFA score of 1. The lower the MAP, the higher the SOFA scores. For hypotension unresponsive to the fluid bolus, vasopressor and inotropic medications are given and must always be given in a dedicated line and discontinued gradually.

• CNS organ dysfunction is determined by the Glasgow Coma scale. Normal is 15. Anything less indicates neurologic organ dysfunction. Altered mental status also includes changes in personality, affect, mentation and cognition. This component was minimally reviewed in the old guidelines. Altered mental status has now become a critical indicator, especially since it is part of the qSOFA criteria.

• Renal organ dysfunction is determined by creatinine level in mg/DL or urine output. A creatinine level of < 1.2 is normal. The higher the number, the higher the SOFA scores. The creatinine level is calculated to determine the glomerular filtration rate (GFR) which should be about 60 to 120 ml/minute. For urine output, an easy measure when taking care of patients is that we like to see 1 ml/min.

The clock starts when two or more SOFA organ dysfunctions occur. Note the time because critical interventions and treatments must take place within the first hour. According to the Society of Critical Care Medicine and the Surviving Sepsis Campaign, the following activities must occur and be recorded. Measure blood work with lactate level, obtain anaerobic and aerobic blood cultures and follow with administrating broad spectrum antibiotics, again, all within the first hour. Administer a bolus of fluid of 30 ml/Kg crystalloid. Normal

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A NEW LOOk AT SEPSIS

Saline is the first choice for hypotension or for serum lactate > 2 mmol/L. Follow up with serial lactate levels and review antimicrobials that are given. Identification of the primary focus of infection is the single most important goal of management. Since ICU staff in general, is familiar with sepsis protocol it will not be discussed further in this article.

Sepsis is a medical emergency. Stop sepsis early. Develop a team like a code team. Have an up-to-date screening and treatment tool. Everyone should know where it is and how to proceed. Nurses must be clear on permitted activities like ordering blood cultures and lactate, or drawing blood. For non-ICU nursing units, do a qSOFA every day, on every patient, on every shift.

Nursing priorities in caring for post-sepsis patients from ICU include a comprehensive hands-off report where both nurses are at the bedside for the initial assessment. Inspire patient confidence, introduce yourself, and listen to the patient and reporting nurse regarding the sepsis history and primary problems. Together, review drains, chest tubes, catheters, dressings, IVs, medications and labs. Review mentation. Know what to watch for and who to call. The nursing focus should include relieving the patient’s anxiety and pain, delirium management, DVT and stress ulcer prophylaxis, and respiratory therapy to keep the SpO2 > 92%. Monitor cognition. The patient may need a nutrition consult, and physical and/or occupational therapy, particularly if limbs are missing.

Preparing the patient and family for discharge should start immediately, well before discharge. Include being very aware of possible relapse and reinfections. The home situation should be evaluated for possible visiting nursing services or other community assistance. Review the importance of follow up visits, particularly regarding medications. Work with the hospital discharge planner. The patient should know resources for after discharge such as walk-in clinics, who to call if things change and contact info for home health care and support groups. Teach the patient to monitor his/her condition. Take temperature and blood pressure, do daily weights, have good hygiene and nutrition, take prescribed medications without fail, get enough sleep and if things change, don’t wait to get sicker. Teach them to notify their healthcare provider immediately.

Much of this may seem rather ordinary and is what you would do for all your patients. But remember, post

ICU sepsis patients have been very traumatized. Perhaps they have been sedated on a ventilator for a week or more, needed continuous renal replacement therapy (CRRT), on vasopressors or inatropes with cardiac arrhythmias, watched their limbs die from sepsis or even necrosis from vasopressors, or perhaps they reached a point where they wanted to give up. Their ability to recover to their previous state has

been severely compromised. Let’s give them the tools they need.

There are many organizations that provide education and tools to start sepsis programs. The Surviving Sepsis Campaign www.survivingsepsis.org was formed in 2001. The group works closely with the Society of Critical Care Medicine (SCCM) http://www.sccm.org/sepsisredefined to develop guidelines, treatment bundles, data collection and so much more. Another group is the CDC https://www.cdc.gov/sepsis. The variety on this site regarding sepsis is amazing. If you go to the link “Improving Survival through Policy and Collaboratives,” you will find examples from many hospitals and organizations how they implemented a sepsis policy. If you are a world traveling nurse the World Sepsis Congress http://www.worldsepsiscongress.org/ gives regular webinars. This site is often high level education, but I remember a story from a mother from England with her 18-month old son who died of sepsis. She went through the delays with their medical system, but she said she wished she would have been more proactive in demanding a sepsis screening. A similar situation in the U.S. where a father watched his 23-year-old daughter die after a hemorrhoid operation and started the Sepsis Alliance http://www.sepsis.org/ which is very proactive in community

activities and how to start sepsis support groups as well as good information on early identification. It also has some amazing stories of sepsis survivors. The jamasepsis.com is the journal website. If you just want to do your own research, go to google and type sepsis 2016. My favorite reference for this article is Dr. Richard H. Savel, MD, FCCM. https://www.youtube.com/watch?v=UevCJSRGJkA.

In summary, Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is defined as a subset of sepsis in which profound circulatory, cellular and metabolic abnormalities are associated with a greater risk of mortality than sepsis alone. Outside the ICU, patients with suspected or presumed infection who are highly likely to have poor outcomes can be clinically identified using 2 qSOFA scores, and in the ICU, patients with suspected or presumed infection who are highly likely to have poor outcomes can be clinically identified by the presence of 2 or more SOFA criteria. Patients with septic shock can be clinically identified if, despite adequate resuscitation, they require vasopressors to maintain the MAP ≥ 65 mm Hg AND their serum lactate level is > 2 mmol/l.

In conclusion, we might still use SIRS as an initial heads-up for a possible infection, but we now have real tools that are measurable. Let’s use them. We are our patient’s first advocate. Don’t let our patients deteriorate to the point where they have to be on CRRT, or sedated on vents, have cardiac arrhythmias, be on vasopressors & inatropes, have cognitive decline, or lose limbs. Know and establish sepsis protocols to identify sepsis and treat it early.

References H-CUP Statistical Brief #160; National inpatient costs: the most

expensive conditions by payer, 2011. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb160.jsp. Retrieved 10:01:2016

Kleinpell RM, Schorr CA, Balk RA. The new sepsis definitions: implications for critical care practitioners. American Journal of Critical Care. 2016;25(5):457-462

Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-810.

The link for the SCCM webinar. Mentioned in the first paragraph.https://www.youtube.com/watch?v=M-wL4Mbm2EQ

The charts retrieved from Dr. Savel’s YouTube presentation.https://www.youtube.com/watch?v=UevCJSRGJkA

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Nearly 240 nurses and student nurses gathered in the Hall of Governors on February 17th to learn about current legislation. A dozen or so legislators joined us and spoke to issues and bills in health care they are supporting. Legislators discussed everything from “epi pens” to Medicaid expansion and spoke at length on clean air legislative efforts and telehealth. We shared the very good news that SB 48, the Nurse Licensure Compact Bill has passed and Utah will continue as a compact nursing licensing state into the future. The need for increased funding of state schools of nursing through the efforts of the Nursing Consortium was presented by Teresa Garrett. All these subjects inform us as both nurses and as health care recipients.

Some attendees may not realize that bills specific to nursing must be sponsored by a legislator and all bills require a groundswell of research and support from a wide base before they become bills, hopefully passing into law. If there are no bills about nursing in a given year, we look at bills on broader issues. However this year SB 48, sponsored by Senator Evan Vickers and Representative Ray Ward was a very important nursing bill that succeeded in passing both the House and the Senate and, at this writing, awaits the Governor’s signature. This bill allows nurses in Utah to be licensed in Utah and to thereafter be able to work in any compact state without getting a separate license for each state. Eleven states have now passed this legislation which will go into effect when either 26 states have passed the legislation or by December 31, 2018 – whichever is sooner. Until this occurs, the current compact act is still in place. Historically Utah nurses wrote the first Compact Act and set the pace for the nation in 2001. Ultimately 24 states joined that Compact. The new and revised Compact clarifies uniform standards for licensure and establishes a Commission to facilitate communication and decisions about the Compact among member states.

At least two legislators shared what approaches in advocacy work best from their point of view. Person

N u rses’ Day at t h e u ta h stat e LegisLat u r e 2017to person discussions before and during the general session are best. Emails or phone calls where the constituent includes their name, mailing address and zip code are both effective with the qualifier that the legislators receive thousands of communications during the general session and may not be able to respond to all constituents. Form emails with identical subjects and content get little reaction but timely, informative communications are very welcome.

Legislators presented bills they sponsored or supported that they hold to be important to them and the nursing community. Here follows materials presented by some of the legislators.

Senator Allen Christensen spoke how as a pediatric dentist and a senator for 12 years now, he has been able to sit around the table and talk to other legislators about his viewpoint of Medicaid expansion. Senator Christensen positioned that federal tax breaks and money earmarked for Utah’s Medicaid expansion was somehow “tainted money and not all that free.” There was good dialogue and questioning from the audience regarding Utah’s decision to decline the federal tax dollars. Some spirited audience participation ensued. Senator Brian Shiozawa, an Emergency Room physician at St. Mark’s Hospital, had a different opinion as he has worked endlessly in an attempt to sponsor bills to get Medicaid expansion passed. Senator Shiozawa informed the audience how he was in favor of accepting the federal funding but has been unsuccessful with passing legislation within the legislative process.

Senator Shiozawa spoke about the many uses of medicinal marijuana and of his strong support. He noted that the CBD Study Bill (SB219) has passed which will allow research to clearly identify uses, doses, and types of medical marijuana to eventually be legalized in Utah. Senator Shiozawa also discussed the need for legally allowing a wider variety of epinephrine delivery devices in Utah (SB 108). He noted the astronomical rise in cost

of epi pens when that was the only legally authorized type of device. He views this bill as one to encourage competing device manufacturers to lower prices. He regards this as a notice to pharmaceutical companies that unbridled cost increases will be fought in Utah. He ended with thanking nurses for “keeping the hospitals running whether it was the ER, OR, or the regular units in the hospital, the hospital cannot function without you nurses and I appreciate all that you do to keep the hospitals running.”

Representative Patrice Arent, one of the co-founders and the co-chair of the bipartisan clean air caucus, spoke about clean air quality legislation she has worked hard to sponsor. She indicated almost 50% of pollution comes from vehicles and the second most significant source are area sources, including buildings. We need better standards for vehicles and their fuels, as well as, stricter building standards. We reviewed positive actions we as citizens can take daily such as minimizing idling of our vehicles. There were questions from the audience about the statistics associated with air quality and the size of penalties for violating environmental regulations. Representative Arent did note that although only 11-33% of pollution comes from industry, the penalties for not meeting environmental standards, including air quality standards, have not changed in 36 years. “We need more rigorous fines.” Arent concluded that clean air is good for health and bad air quality is bad for both our health and our economy – discouraging businesses and tourists from coming to the state.

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N u rses’ Day at t h e u ta h stat e LegisLat u r e 2017One basic area of improvement is replacement of

out-dated or damaged monitors that identify amounts and types of pollutants in the air. [In the final approved budget, the full request for air monitoring funds for replacement of obsolete equipment and the addition of a new required air monitoring center in Cedar City was completely funded with $1.3 million one-time funding and $150,000 ongoing funding.] Some progress is made and yet much remains to be done to improve air quality and the environment that affects all Utahan’s, once we can quantify the size of the problem, partly with this much-needed equipment. Read more in the next Utah Nurse.

Representative Carol Spackman Moss spoke about her legislation in two key areas, Physical

Restraint in Schools (HB 92) which clearly abolishes use of corporal punishment in schools and

advocates less intrusive physical force such as physical escort for acting-out. This legislation does allow physical restraint to be used in very specific instances, to protect the child from harm to self or others. Ultimately this bill did pass. She also addressed the opioid epidemic in her bill for Opiate Overdose Response Act (HB 66) which will allow one overdose outreach provider to legally give a dose of an opiate antagonist to another outreach provider or a family member or friend of a drug user at risk of overdose. This bill also eliminates the civil liability for administration of the opiate antagonist by an opiate outreach provider who is acting reasonably and in good faith. (Liability is not eliminated for any health care worker who is working within their employment setting and scope of

practice.) This bill also passed the legislature and builds on work Representative Moss has done in recent years.

Representative Ken Ivory spoke about his Telehealth Bill (HB 154) which recognizes the extent of care being offered across state lines. He noted the challenges for insurance companies to reimburse for this type of care. These companies do not want to be mandated to provide parity of coverage to cover in-person patients and telehealth or “virtual” patients at the same level. This bill requires insurance companies to be transparent about payments with a mandate that insurance companies will reimburse for mental health care.

The bill also requires DOPL and Division of Workforce Services report on the actual practice and reimbursement of telehealth care, looking at synchronous vs asynchronous deliveries. The scope of telehealth or telemedicine being practiced in Utah, the methods of payment both in Utah and in other states and the extent to insurance is coverage, including mental health care are also required in the reporting. These findings are to be reported to two interim task forces or committees. Representative Rebecca Edwards contributed to this discussion while presenting a proposed pilot study to compare mental health coverage for telehealth patients and in-person patients.

Representative Jim Dabakis passionately presented the need for Medicaid expansion. Some audience members were clearly strong Medicaid expansion proponents and agreed with Rep. Dabikis as they had equally loudly disagreed with Senator Christensen.

A couple of newly elected female legislators came to encourage more women to consider running for public office. They were Representative Karen Kwan and Representative Elizabeth Weight who won their elections in Nov. 2016.

Evaluation of the Day: We value your feedback and evaluations to improve this

critical conversation with our legislators. Despite several evaluators complaining of poor audio, most attendees said they could hear the speakers without difficulty. We will increase the number of speakers for the audio system by two for next year. Regular attendees of Nurses’ Day on the Hill reported that the audio was far superior in the Hall of Governors to that in the Rotunda in recent years.

The complimentary breakfast was well-received. Given some interest in having a “working” breakout session, we will add a breakout room next year for those who want to work on specific bills or learn more about advocacy regarding issues of interest. For those of you who want to get more involved, you are most welcome to meet with GRC members at that time.

We activated our new advocacy tool to encourage the Governor to sign SB 48, the Nurse Compact Act bill. Many signed on as advocates and over 30 carried through the entire process to actually contact the Governor. We hope that many more will eventually sign up to use the advocacy tool on key issues and bills in the future. If you want to sign up, just email the UNA office at una@xmission.com, leave your name, mailing address with zip code, and cell phone number. Angela York, our Director of Communications led us in this advocacy exercise. There is not a requirement to be a member of UNA to be included in our advocacy group, though we would really like you to join us. Less than 500 members work towards protecting the Nurse Practice Act and advocating for 26,000 nurses in Utah. Join us and get involved. We’d love to welcome you as a new member.

Next Year’s Nurses Day on the Hill:Those of you who want to prepare for the 2018

General Session, join us for Advocacy Day on October 12th. Watch our website for more information as plans are made. Next year’s Nurses’ Day on the Hill will be February 9th from 0800 to 1000 for the main session in the Hall of Governors with a breakout session from 1000 to 12 noon in the Beehive Room in the Senate Building.

Brandie Williams(RN all the way from Hawaii)

Donna Murphy, Senator Brian Shioziowa & Kathleen Kaufman

Donna Murphy & Representative Ken Ivory

Utah Nurse • Page 10 May, June, July 2017

NURSES ON THE NATIONAL FRONT

The Alumni Association awards its annual $8,000 Founders Day Scholarship (its largest single award) to a student who has overcome difficult life circumstances or challenges and who has given service to the university and the community. This may be one of only a very few instances where the Founders Day Award is presented to a national leader and expert in a profession while the full tuition scholarship is awarded to a beginner in the same.

The University of Utah, Alumni Association’s Annual Founders Day Awards & Dinner

Dr. Cipriano accepting award Sydney Chan was named the 2017 Founders Day Scholar

Dean Morton and Dr. Cipriano

Courtesy of The U of U Alumni Association

Sydney Chan, was named the 2017 Founders Day Scholar. She credits her cultural identity with making her who she is—a successful student nurse, an active volunteer with several groups supporting the underrepresented, and an outstanding service leader with the U’s Bennion Center.

Sydney’s parents are African American and Chinese, so she was raised in both cultures and traditions. “My

Rebecca Walsh, Associate Director of Communications, U of U College of Nursing

Pam Cipriano was honored for her lifelong work as an advocate for and leader of nursing. Currently she serves as the President of the ANA and speaks out regularly to protect you, the working nurse. Cipriano has received the Founders Day Award as an Alumna of the University of Utah’s College of Nursing. Read on to appreciate the considerable contributions Dr. Cipriano has made locally and nationally to nursing.

In retrospect, Pam Cipriano’s future as a national nursing leader was obvious.

But while Cipriano was pursuing a Ph.D. at the University of Utah College of Nursing, she was simply the go-to co-worker and boss.

“Pam created an environment that was safe and welcoming,” said Vanessa Laurella, an assistant professor at the College of Nursing. Laurella worked with Cipriano at University Hospital 30 years ago. “She was always the lead advocate for the nursing staff on her units.”

Cipriano was honored as a Distinguished Alum of the University of Utah in a ceremony on Founders Day, March 3. But her colleagues and friends remember her, first and foremost, as a passionate supporter of nurses.

Her long career in healthcare wasn’t a foregone conclusion. The daughter of a custom homebuilder and a homemaker, Cipriano grew up outside Philadelphia. She started college intending to study elementary education. But when that didn’t fit and she shifted to nursing, her Sicilian grandmother thought she was crazy.

Cipriano’s first job after graduating from the Hospital of the University of Pennsylvania’s School of Nursing was as a staff nurse in Salt Lake City at the U. Having been the president of the National Student Nurses Association, she was recruited to join the hospital’s newly formed staff nurse advisory council—part of a core group of student leaders from the Intermountain West who were empowered by hospital administrators.

“Staff didn’t usually rise to the level of having much of a voice back then,” she said. “But we were determined to shake up the place.”

That University Hospital proving ground set her on a trajectory of advocacy for nursing that has defined her career.

Cipriano left Utah a year later to pursue her bachelor’s degree in nursing at American University in Washington, D.C. before she headed back west to pursue a master’s degree with a specialty in burn, trauma, and emergency nursing at the University of Washington.

In 1981, Cipriano returned to Utah as the adult critical care clinical nurse specialist, her “dream job.” Eventually, she became an assistant director of nursing. The healthcare market was volatile, and in 1983, Cipriano had to lay off a number of staff after the federal government changed Medicare reimbursement formulas.

“It was quite an experience for someone who was brand new to management,” Cipriano said. “I can still remember one young woman in tears with black eyeliner and mascara running down her face. That’s one of those things I will never forget.”

In 1984, Cipriano helped organize the move of 300 patients into a then-spanking new University Hospital

Pam Cipriano Receives Founders’ Day Award from the University of Utahbuilding over a 36-hour period. To make time for her doctoral studies at the College of Nursing she went to work at Intermountain’s LDS Hospital as the manager of the shock-trauma unit. Her research on labor economics and the impact of unionization and the feminist movement on nursing salaries from 1960 to 1990. And she found a paradox: “Nurses were perceived as already having achieved more independence and ability to dictate what happened in their workplace” than other women. As a result, nursing salaries have lagged, barely keeping up with inflation. And nursing salaries continue to vary based on periodic workforce shortages, Cipriano says.

“Pam always spoke up for patients, their families and the quality of care they should receive,” said Linda Amos, Cipriano’s thesis advisor and emeritus dean of college. “Her passion about the quality of care continued from the time she was a student and throughout her professional career.”

After earning her Ph.D. in 1992 through the college’s distance program, Cipriano taught at Medical University of South Carolina College of Nursing while also working as clinical director of the academic medical center’s cancer center and, later, as director of surgery trauma services. From 1995 to 2000, Cipriano took the helm at Medical University, running operations at a $210 million health care system with 2,600 employees. In 2000, Cipriano moved with her husband and two young daughters to take a post at the University of Virginia as Chief Clinical and Nursing Officer for that academic medical system, managing 3,500 employees and a $350 million budget. In 2010, Cipriano was named the Distinguished Nurse Scholar-in-Residence at the Institute of Medicine (now the National Academy of Medicine). In 2012, she moved into the private sector, working for Galloway Consulting, advising on healthcare management.

Two and a half years ago, Cipriano was elected president of the American Nurses Association, representing the interests of the nation’s 3.6 million registered nurses. In that role, she has spoken out about keeping patients and staff safe during threats like Zika virus, and healthcare reform, more specifically, Obamacare.

The impact of constant change in the healthcare marketplace on nurses—and their patients--is at the forefront of her mind.

“Nurses feel very strongly about protecting the rights of the public to healthcare. There’s an economic concern and a social responsibility,” Cipriano said. “When people can’t afford healthcare, they delay getting needed care, putting off important preventive care or delaying diagnoses, and they get sicker, using the ER as their place of care. It creates a logjam in the healthcare system. That’s why nurses care about healthcare coverage.”

She’s closely monitoring Washington’s talk of repealing and replacing the Affordable Care Act.

Her friends and colleagues back in Utah wouldn’t expect anything less.

“It was very clear she was a champion for nursing and poised for national leadership that would advance the profession,” said Kathi Mooney, a professor at the College of Nursing and former colleague.

Sydney Chan, 2017 Founders Day Scholarbeliefs have saved me many times, and the traditions sustained by my family have had an enormous impact on me,” she says. “I am very proud of my heritage and hope to build confidence, courage, and character in those I help.”

But Sydney’s life wasn’t always so bright. For many years, comments about her mixed heritage affected her confidence and made her question who she is. At one point, she felt painfully misjudged based on racist stereotypes. “I was hurt and frustrated that because of my skin color, people assumed I was scary, bad, a lowlife,” she recalls. “But I quickly snapped out of it when I remembered all the beautiful teachings my cultural background has given me.” Sydney uses these experiences as motivators to make a difference and help others who might have experienced similar hardships.

Sydney gained leadership experience working with girls from refugee, homeless, and domestic abuse shelters, and became involved with diversity committees and underrepresented student groups at the U. “Through my involvement on campus, I’ve been able to understand how my culture and beliefs have shaped me,” she says. “As I further my nursing career, I’m determined to take my experiences and use them to advocate for my patients and their beliefs.”

BSN-LINC: 1-877-656-1483 or bsn-linc.wisconsin.eduMSN-LINC: 1-888-674-8942 or uwgb.edu/nursing/msn

RN to BSN Online Program MSN Online Program

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May, June, July 2017 Utah Nurse • Page 11

FROM THE MEMBERSHIP COMMITTEESharon K. Dingman, DNP, MS, RN

Membership Committee Chair

UNA joins with ANA in informing our members and perspective members about the valuable professional information available to membership. The information in this article is found in the ANA Member Guide Information folder [(©AHA, 2014 ANA-BRO6 (6/16)]. We encourage you to renew your membership. http://www.nursingworld.org/joinana.aspx

Benefits for ANA/UNA members includes access to professional tools you will use in your professional life, including research tools, nursing resources, etc. ANA membership totals 3.6 million registered nurses and UNA membership totals 450 registered nurses. You can access these resources through your MyANA account at NursingWorld.org/MyANA.

Being a member of ANA/UNA makes a powerful statement about you and your commitment to nursing and provides a way for member nurses across the United States and Utah to speak with one strong voice on behalf

Sharon K. Dingman

of nursing and our patients. Continuing education and member programs provide access to learning opportunities to keep you up-to-date in nursing knowledge and advance your career.

You will find information about healthy work environments that are safe, empowering, and satisfying. Nurses taking care of their own health, take better care of patients.

Connect through social media with your state and national association. Visit the UNA website to learn more. http://www.utnurse.org.

You can stay up-to-date through journals and publications: American Nurse Today (monthly journal); The American Nurse: ANA’s official newspaper, The Online Journal of Issues in Nursing (OJIN) by using your member login at Nursing World.org/OJIN, E-Newsletters: ANA SmartBrief, ANA Nurse Career Brief, Nursing Insider, and Member News.

For additional information: Contact una@xmission.com

IMPORTANT CONTACTS AT-A-GLANCE ANA Member Services: 1-800-923-7709 FAX: 1-301-628-5355 Mail: American Nurses Association 8515 Georgia Avenue, Suite 400 Silver Spring, MD 20910

Update Your Profile: NursingWorld.org/MyANA

ANA E-mail Addresses: • Membership: memberinfo@ana.org • American Nurses Foundation (ANF): anf@ana.org • ANA-PAC: ana-pac@ana.org • NursesBooks.org: anp@ana.org • Ethics Issues: ethics@ana.org • Lobbying — Federal and State: gova@ana.org • Meetings and Conferences: meetings@ana.org

Look up your state nurses association’s contact information by going to NursingWorld.org

Professional Development and Networking Resources Online: • ANA Career Center: NursesCareerCenter.org • ANA Leadership Institute:

ANA-LeadershipInstitute.org • ANCC Certifications: NurseCredentialing.org • Book Discounts: NursesBooks.org • Online Continuing Education: ANANurseCE.org • Navigate Nursing: NavigateNursing.org

American Nurses Credentialing Center: 1-800-284-CERT (2378)

A Voice for NursingUNA leaders represent your interests in a wide variety

of meetings, coalitions, conferences and work groups throughout the year, anticipating and responding to the issues the membership has identified as priorities. In addition to many meetings with legislators, regulators, policy makers and leaders of other health care and nursing organizations, the following is a partial list of the many places and meetings where you were represented during the past three months....

• UNABoardMeeting• Health andHumanServices InterimCommittee of

Utah State Legislature• UtahNursingConsortium• UniversityofUtahFounder’sCelebration• StateBoardofNursing• UNABoardAnnualStrategicPlanningConference• WestminsterCollegeRNtoBSSeminar• CollegeofNursingattheUniversityPolicyClass• NursePractitionerDayontheHill• SenateHHSCommittee• HouseHHSCommittee• HouseBusinessandLaborCommittee• SenateBusinessandLaborCommittee• HigherEducationAppropriationsCommittee• HealthcareRoundtableattheCapitol• NursesDayontheHill

George E. Wahlen VA Medical Center The Salt Lake City VAMC is seeking exceptional nurses for positions in the Operating Room, Intensive Care Units, and Medical-Surgical Wards. We regularly have openings for Board certified Psychiatric Advanced Practice Nurses. Please visit VACareers.va.gov for benefit information.

Apply Today:

USAJobs.gov

Follow VA Careers

VA nurses have the opportunity to participate in research initiatives focused on enhancing health and preventing disease among our Nation’s heroes. And, you’ll be able to further your career through our various nursing leadership and clinical development programs.

What’s more, you will have the freedom to practice at any one of the over 1,400 VA medical facilities throughout the 50 states, the District of Columbia, and other U.S. territories—with only one active state license.

For more information, contact Amber Brennan, RN - Nurse RecruiterPhone: 801-582-1565 ext 1128 or email amber.brennan@va.gov

HAPPY NATIONAL ê NURSES WEEk ê

Ou tside COnsultant POsitiOnPEHP, a nonprofit trust providing health benefits to Utah’s public employees, is seeking licensed practitioners (NP, APRN, PA, PsyD) to consult on a contracting basis for our Long-Term Disability Program.

Visit pehp.org; ltd info under “Our Products” tab.

Part-time, flexible hours, we will train youMust be currently seeing adult patientsReview medical records, contact doctors & claimantsMost work performed via secure internet Collaboration and effective communication requiredWork overseen by our MD Consultant

if interested send resume & current patient responsibilities/specialty to angie.benson@pehp.org.

Usually, a healthcare provider’s license is their most important asset. Disciplinary and malpractice action taken against that license not only becomes public information, but can have a devastating impact on one’s ability to practice. Catherine

Larson has over 20 years of experience defending providers in these matters. Her expertise can help guide you through this

challenging process.www.strongandhanni.com

clarson@strongandhanni.com • 801.532.7080

102 South 200 East, Suite 800, Salt Lake City, UT 841119350 South 150 East, Suite 820, Sandy, UT 84070

Utah Nurse • Page 12 May, June, July 2017

IN MEMORIAM Marie Blanche Fuller passed away December 25, 2016. She earned a nursing

degree from Brigham Young University. As an R.N., Marie dedicated her career in service to others. She specialized in helping those with mental health issues at LDS Hospital and University Medical Center. 

Alice Setsuko Hirai passed away December 24, 2016. In 1962, she earned her B.S. at the University of Utah with a degree in Nursing. As a nurse, she served in several capacities; public health nurse, home health nurse, school nurse, and floor nurse. During her time as a nurse she had passion that few others possessed, which helped sustain her career for 54 years until her retirement in the spring of 2016. 

Peggy Jane Reed passed away December 21, 2016. Her career in the medical field began as a labor and delivery nurse. She worked as a school nurse in Utah and then embraced her real passion, maternity and newborn research at the University of Utah. That work led to a research management position at Intermountain Medical Center.

Bonnie Charlotte Bloom LeFevre passed away January 14, 2017. She went to the University of Utah, where she earned a degree in nursing. After a year at a maternity hospital in Honolulu, Hawaii, she returned to the mainland. Her nursing

practice led her to Monterey California, Salt Lake City & Bountiful, Utah. She was a nurse at Veterans Administration Hospital in Salt Lake City, as well as a public health nurse in Davis and Salt Lake Counties.

Nadine Oldroyd Ward passed away December 29, 2016. She earned her Bachelor’s Degree from The Holy Cross Nursing School, followed by a Masters in Psychiatric nursing from the University of Utah. Her working years were spent in this profession at the VA Hospital in Salt Lake City.

Janice Rose passed away February 09, 2017. She went to Weber State University and graduated with a nursing degree in 1976. She was employed at Dee Hospital, University Medical Center in Salt Lake City, and later joined her sister Marilyn on United Airlines as a nurse stewardess.

Mark Daniel Montgomery passed away February 19, 2017. Mark graduated from Weber State University with a bachelor’s degree in nursing. For the past 7 years he worked for Intermountain Healthcare, where he loved his work and was known for his skill and dedication. Mark enlisted in the Utah National Guard after graduating from the Weber State ROTC program as an officer. He was a Captain in the Medical Command Unit where he served as a medic.

Georgia Hunter Merrill passed away February 14, 2017. Georgia is a graduate of the LDS Hospital School of Nursing with a degree from the University of Utah. She worked as a nurse in Utah, Idaho, and California.

Darleen Handy passed away February 18, 2017. After earning her R.N. degree at Weber State College, she started her lifelong career helping others as if they were her own family. During her time as a R.N. she worked at Intermountain Organ Recovery eventually landing at IMC in the Cardio Cath Lab.

Utah Enacts Enhanced Nurse Licensure Compact (eNLC)

CHICAGO – Utah has joined Arizona, Florida, Idaho, Missouri, New Hampshire, Oklahoma, South Dakota, Tennessee, Virginia and Wyoming as a member of the eNLC. Gov. Gary Herbert signed the bill March 15, 2017.

Allowing nurses to have mobility across state borders, the eNLC increases access to care while maintaining public protection. The eNLC, which is an updated version of the current NLC, allows for registered nurses (RNs) and licensed practical/vocational nurses (LPN/VNs) to have one multistate license, with the ability to practice in both their home state and other NLC states. The eNLC will come into effect the sooner of 26 states enacting the eNLC or Dec. 31, 2018. All states, including those participating in the existing NLC, must introduce legislation in the coming years to enter into the enhanced NLC.

“The Utah Organization of Nursing Leaders was pleased to take the lead on this important legislation,” comments Teresa Garrett, DNP, RN, APHN-BC, project director, Utah Nursing Consortium. “Maintaining Utah’s participation in the NLC was a priority for many professional organizations and partners, including the Utah Nurses Association and the Utah Action Coalition for Health. We know that the eNLC will raise the bar on patient safety by ensuring background checks and the appropriate sharing of information across state lines.”

Patient safety being of paramount importance led to the addition of new features found in the provisions of the legislation of the eNLC. Licensing standards are aligned in eNLC states so all nurses applying for a multistate license are required to meet the same standards, which include a federal and state criminal background check that will be conducted for all applicants applying for multistate licensure.

The eNLC enables nurses to provide telehealth nursing services to patients located across the country without having to obtain additional licenses. In the event of a disaster, nurses from multiple states can easily respond to supply vital services. Additionally, almost every nurse, including primary care nurses, case managers, transport nurses, school and hospice nurses, among many others, needs to routinely cross state boundaries to provide the public with access to nursing services, and a multistate license facilitates this process.

Boards of nursing (BONs) were the first health care provider regulatory bodies to develop a model for interstate practice with the original adoption of the NLC in 1997 and its implementation in 2000. While other health care provider regulatory bodies are just getting started in this process, the NLC has been operational and successful for more than 15 years.

Additional information about the eNLC can be found at www.nursecompact.org.

About NCSBNFounded March 15, 1978, as an independent not-for-profit organization, NCSBN

was created to lessen the burdens of state governments and bring together boards of nursing (BONs) to act and counsel together on matters of common interest. NCSBN’s membership is comprised of the BONs in the 50 states, the District of Columbia, and four U.S. territories — American Samoa, Guam, Northern Mariana Islands and the Virgin Islands. There are also 27 associate members that are either nursing regulatory bodies or empowered regulatory authorities from other countries or territories.

NCSBN Member Boards protect the public by ensuring that safe and competent nursing care is provided by licensed nurses. These BONs regulate more than 4.5 million licensed nurses.

Mission: NCSBN provides education, service and research through collaborative leadership to promote evidence-based regulatory excellence for patient safety and public protection.

The statements and opinions expressed are those of NCSBN and not the individual member state or territorial boards of nursing.

Copyright © 2017 NCSBN, All rights reserved.Utah Nurses Association | 4505 S. Wasatch Blvd, #330B | Salt Lake City, UT 84124 | Phone 801-272-4510

May, June, July 2017 Utah Nurse • Page 13

Nursing Grant-in-Aid Scholarship Guidelines

To download application, visit www.utnurse.org.

The guidelines listed below shall assist in ensuring the best possible coordination in receiving and processing nursing student requests for scholarships. Scholarships will be awarded for tuition and books only.

SCHOLARSHIP INFORMATION:• Scholarshipsmust bepostmarked by June 1st or October 1st of each calendar

year to be considered. • ApplicantswillreceivenoticeoftheBoard’srecommendationsbyJuly15thandOctober

15th of each calendar year.• Recipientsareonlyeligibletoreceivescholarshipstwice.• Applicantsmustabidebythecriterialistedbelow.

GENERAL SCHOLARSHIP CRITERIA:The applicant must:• Haveacumulativegradepointaverage,whichisequivalenttoa3.0orhigherona4.0scale.• BeaUnitedStatescitizenandaresidentofUtah.• Havecompletedaminimumofonesemesterofcorenursingcoursespriortoapplication.• Ifastudentinundergraduatenursingprograms,beinvolvedintheschool’schapterof

the National Student Nurses Association.• If a registered nurse completing a Baccalaureate Degree or an Advanced Nursing

Degree, be a member of Utah Nurses Association (state only) or a member of Utah Nurses Association/American Nurses Association.

• Submitapersonalnarrativedescribinghis/heranticipatedroleinnursinginthestateofUtah that will be evaluated by the Scholarship Committee.

• Submitthreeoriginallettersofrecommendation.Letterssubmittedfromfacultyadvisorand employer must be originals addressed to the Utah Nurses Foundation Scholarship Committee.

• Beenrolledinsixcredithoursormorepersemestertobeconsidered.Preferencewillbegiven to applicants engaged in full-time study.

• Demonstrate a financial need. All of the applicant’s resources for financial aid(scholarships, loans, wages, gifts, etc.) must be clearly and correctly listed (and include dollar amounts and duration of each source of aid) on the application.

• TheScholarshipCommitteeshallconsiderthefollowingprioritiesinmakingscholarshiprecommendations to the Board of Trustees: ¡ RNs pursuing BSN¡ Graduate and postgraduate nursing study¡ Formal nursing programs - advanced practice nurses ¡ Students enrolled in undergraduate nursing programs

• TheApplicantisrequiredtosubmitthefollowingwiththecompletedapplicationform:• Copyofcurrentofficialtranscriptofgrades(nogradereports).• Threelettersofrecommendation:¡ One must be from a faculty advisor, and¡ One must be from an employer (If the applicant has been unemployed for greater

than 1 year, one must be from someone who can address the applicant’s work ethic, either through volunteer service or some other form).

¡ At least one should reflect applicant’s commitment to nursing.¡ All must be in original form,¡ All must be signed and addressed to the UNF scholarship committee.

• Narrative statement describing applicant’s anticipated role in nursing in Utah, uponcompletion of the nursing program.

• Letterfromtheschoolverifyingtheapplicant’sacceptanceinthenursingprogram.• CopyofIDfromNationalStudentNursesAssociationorUtahNursesAssociationwith

membership number.

AGREEMENTIn the event of a scholarship award:• ThenursingstudentagreestoworkforaUtahHealthCareFacilityorUtahEducational

Institution as a full-time employee for a period of one year, or part- time for a period of two years.

• Student recipient agrees to join the Utah Nurses Association within 6 months ofgraduation at the advertised reduced rate.

• IfaskedbyUNF,providepersonalpicturesandnarrativestobepublishedinThe Utah Nurse indicating that UNF scholarship funds were received.

• If for any reason the educational program and/or work in Utah is not completed, thescholarship monies will be reimbursed to the Utah Nurses Foundation by the nursing student.

This form is to be used to request research funding assistance from Utah Nurses Foundation (UNF). Completed forms should be submitted electronically to UNF in care of the Utah Nurses Association at UNA@xmission.com. Requests will be evaluated based on need, support for nursing and the nursing profession, and available UNF funds.

Those receiving funds may be asked by UNF to provide personal pictures and narratives to be published in The Utah Nurse indicating that UNF funds were provided for this project.

Title of project: __________________________________________________________________

Applicant’s Name and credentials: _________________________________________________

Professional Association/Affiliations (if any): __________________________________________

Are you currently a nursing student? Yes No

If a student, what nursing school? _________________________________________________

Pursuing what degree? ___________________________________________________________

Have you received funding for this project from any other source? Explain:

1) Describe the proposed work, paying particular attention to the evaluation criteria listed in the proposal writing guidelines (one page maximum). Project Overview:

Research Process and Desired Outcomes:

Benefits to Patient Care and Education, Nursing Education, and /or Nursing Profession:

2) Describe the proposed budget for this project and how you would use the funds provided (1 page maximum):

3) Provide contact information for you as well as someone who can attest to this projecta) Personal contact information:

b) Contact Information for individual at the School or Facility where research will be conducted:

Each proposal will be evaluated according to the following criteria. Please address these criteria in your description of both the proposed work and the budget.

1) The proposed activity benefits patient care, advances nursing education or research.2) The proposed activity demonstrates merit with regarding to enhancing the discipline of

nursing.3) The proposed activity clearly describes the desired results or outcomes.4) The proposal delineates the efficient use of resources, utilizing a complete and

understandable budget narrative.5) The proposed work offers students and nurses involved a quality, meaningful research

opportunity that will merit submission for publications in a professional journal.

Utah Nurse Foundation use only

Committee discussion of proposal:

Committee decision: Award Do not award

Amount Awarded $ __________________

Is applicant eligible to apply for funds again? Yes No

Nursing Research Grant Proposal

U t a h N U r s e s Fou ndat ion

Learn how to apply at www.utnurse.org/Education

Full-time, 9-month position with the possibility of either a tenure-track or non-tenure track position to start August 16, 2017.

MSN or Doctorate of Nursing required with Utah licensure.

Apply online at www.suu.edu, job #1600037. Please contact Human Resources at jobs@suu.edu or 435-586-7754 if you have questions.

ASSISTANT PROFESSOR OF NURSING

Utah Nurse • Page 14 May, June, July 2017

Looking for a flexible schedule volunteer opportunity to serve your nursing association and your nursing community?

Become a Nurse Peer Reviewer — Supporting Quality Continuing Education

The Western Multi-State Division (WMSD) and its four member associations — AzNA, CNA, INA, and UNA invite qualified nurses to serve as peer reviewers to evaluate continuing education programs for approval. Their expertise supports continuing education activities for the nurses in our four state division and beyond.

The WMSD Accredited Approver Unit will provide training to all qualified Nurse Peer Reviewers to educate them on the ANCC/WMSD accreditation criteria.

Are you:• A currently licensedRNwith aBachelorsDegree in

Nursing or higher?

Become a Nurse Peer Reviewer

Get Smart Preserving the Power of Antibiotics

About Get Smart

Antibiotic resistance causes serious harm around the world and in our own communities— much of it due to inappropriate use of antibiotics. HealthInsight’s Get Smart: Preserving the Power of Antibiotics initiative is your chance to take a stand for eliminating this harm.

Get Smart is a quality improvement and education initiative, aligned with the Centers for Disease Control and

Prevention’s (CDC) Get Smart: Know When Antibiotics Work program, to support clinics and other outpatient facilities in implementing antibiotic stewardship to combat antibiotic resistance.

Reaching 500 clinics and facilities in our four-state region, Get Smart applies antibiotic stewardship principles at the point of care, where antibiotics are being prescribed. HealthInsight’s experienced staff bring up-to-date information on appropriate prescribing practices, as well as supporting clinicians in educating patients about avoiding antibiotics when not warranted.

As a Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO), HealthInsight is experienced in antibiotic stewardship through our hospital and nursing home initiatives on preventing healthcare-associated infections. Through Get Smart, we are working directly with outpatient prescribers, with the goal of increasing the number of clinics and facilities that have incorporated all Core Elements of Outpatient Antibiotic Stewardship (CDC, 2016) by 2019.

Who can participate?• Medicalpracticesandoutpatientclinics• FederallyQualifiedHealthCenters• Hospitalemergencydepartments• Publichealthclinics• Outpatientpharmaciesandpharmacy-basedclinics• Urgentcare

BenefitsYou will...• Receive education on the Core Elements of

Outpatient Antibiotic Stewardship (AS), risks of misuse/overuse of antibiotics in health care and how to talk with patients about antibiotics

• Gain experience in determining which CoreElements of AS your facility has in place or needs to implement

• Acquire tools to assess for and implement AS,including patient outreach and education materials

• Have an opportunity to participate in amultidisciplinary advisory team on AS

• Network with and learn from other local, regionaland national experts working together on AS

• Participate in educational activities that promoteand spread AS best practices in outpatient settings

ExpectationsYou will...• Agree to remain active in Get Smart through July

2019• Agree to publicly disclose participation in this

initiative• Form an interdisciplinary team to incorporate the

Core Elements of Outpatient AS into practice• Identify a clinic lead (administrator) and a staff

champion (day-to-day leader)• Participate in educational network events, other

education sessions, webinars and conferences• Shareresults,bestpracticesandlessonslearned

Visit healthinsight.org/getsmartto sign up today!

1 Antibiotic Resistance National Summary Data. (n.d.). Retrieved Feb. 13, 2017, from https://www.cdc.gov/drugresistance/pdf/3-2013-508.pdf. Infographic courtesy of Telligen QIN-QIO.

This material was prepared by HealthInsight, the Medicare Quality Innovation Network-Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-C.3.10-17-02 3/8/17

Checklist for Core Elements of Outpatient Antibiotic Stewardship

Outpatient clinicians and health care facilities can take steps to implement antibiotic stewardship activities. Use this checklist as a baseline assessment of policies and practices which are in place. Then use the checklist to review progress in expanding stewardship activities on a regular basis (e.g., annually).

Commitment1. Can your facility demonstrate dedication to

and accountability for optimizing antibiotic prescribing and patient safety related to antibiotics?

¨ Yes ¨ No If yes, indicate which of the following are in place

(select all that apply):¨ Write and display public commitments in

support of antibiotic stewardship.¨ Identify a single leader to direct antibiotic

stewardship activities within a facility.¨ Include antibiotic stewardship-related duties in

position descriptions or job evaluation criteria.¨ Communicate with all clinic staff to set patient

expectations.

Action2. Has your facility implemented at least one

policy or practice to improve antibiotic prescribing?

¨ Yes ¨ No If yes, indicate which of the following are in place

(select all that apply):¨ Use evidence-based diagnostic criteria and

treatment recommendations.¨ Use delayed prescribing practices or watchful

waiting, when appropriate.

¨ Provide communications skills training for clinicians.

¨ Require explicit written justification in the medical record for non-recommended antibiotic prescribing.

¨ Provide support for clinical decisions.¨ Use call centers, nurse hotlines, or pharmacist

consultations as triage systems to prevent unnecessary visits.

Tracking and Reporting3. Does your facility monitor at least one aspect of

antibiotic prescribing?¨ Yes ¨ No If yes, indicate which of the following are in place

(select all that apply):¨ Self-evaluate antibiotic prescribing practices.

(This intervention only applies to solo practitioners or practices with fewer than 5 clinicians as long as all clinicians participate.)

¨ Participate in continuing medical education and quality improvement activities to track and improve antibiotic prescribing. (This intervention only applies if all clinicians in the practice participate in the activity.)

¨ Track and report antibiotic prescribing for one or more high priority conditions.

¨ Track and report the percentage of all visits leading to antibiotic prescriptions.

¨ (If already tracking and reporting one of the above) Track and report, at the level of a health care system, complications of antibiotic use and antibiotic resistance trends among common outpatient bacterial pathogens.

¨ Assess and share performance on quality measures and established reduction goals addressing appropriate antibiotic prescribing from health care plans and payers.

Education and Expertise4. Does your facility provide resources to

clinicians and patients on evidence-based antibiotic prescribing?

¨ Yes ¨ No If yes, indicate how your facility provides antibiotic

stewardship education to patients (select all that apply):¨ Use effective communications strategies to

educate patients about when antibiotics are and are not needed.

¨ Educate about the potential harms of antibiotic treatment.

¨ Provide patient education materials.

If yes, indicate how your facility provides antibiotic stewardship education to clinicians (select all that apply):¨ Provide face-to-face educational training

(academic detailing).¨ Provide continuing education activities for

clinicians.¨ Ensure timely access to persons with expertise.

Checklist provided by Centers for Disease Control and Prevention and Centers for Medicare & Medicaid Services (CMS). This material was prepared by HealthInsight, the Medicare Quality Innovation Network-Quality Improvement Organization, under contract with the CMS, an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-C.3.10-17-05

• Interested in joining a unique group of nurse peerssupporting providing ANCC accredited continuing education for the nurses in your community?

• Anurseplanner for educationprogramsandeventsor a primary nurse planner of an Approved Provider unit who wants to stay current in your knowledge of ANCC accreditation criteria?

• Willingtoserveonthevolunteerreviewpanelorasanindependent reviewer?

• Qualified with a background in education, training,and or relevant knowledge and experience in educating nurses that would prepare you to participate in the peer review process

• Proficient in Microsoft Office suite, and accessingemail and email attachments

If so, learn more about the selection and training process at utnurse.org/education under the Nurse Peer Reviewers tab.

May, June, July 2017 Utah Nurse • Page 15

A Short Story by: John KaufmanBased on a True Story

“Something very serious has happened to you. Something that you will deal with for the rest of your life. You have severely broken your C6 vertebrae and you may never walk again…”

Everyone has a fear. Everyone has something that makes you quiver. Fear comes in all shapes and sizes and is directed at each individual differently. Facing our fears is a term often talked about, but rarely accomplished. Sometimes, we’re forced to do this, simply by playing the hand that God has dealt. Life is precious and through the chaos of everyday life, we sometimes forget how quickly it can be taken away. Fear is an unexplainable emotion that grips us all, often when we least expect it. Some have been fortunate enough to have never faced a life and death situation, while the rest of us have stared death in the eyes and now live to tell our stories. When these situations occur, the realization of being mortal is forever evident.

It was a warm Thursday afternoon. The beach was packed, way past the point of annoyance. My friends and I had seen enough underage girls and overweight guys to last us a lifetime. We decided to get in the water one last time, before our evening of girl-chasing (and surely failing) would begin. We raced towards the ocean, dashing through the shallows and into what appeared to be deeper water. Small waves broke at my knees as I made my way further and further from shore. I dove through the next approaching wave. And then it happened. The crown of my head slammed against the ocean floor, feeling more like cement than sand. As my chin pushed against my chest, the bones in my neck gave way to the massive pressure, releasing a crunching and grinding noise that still haunts me to this day. I remember feeling instant regret. John, what did you do? constantly ran through my mind. In the panic of the moment, I opened my eyes and peered through the murky water. I attempted to stand, but nothing worked. My lifeless body drifted face down, for what seemed to be forever. As the darkness began to creep in and my consciousness quietly drifted away, a wave rolled in from above, flipping my body over long enough to catch my breath and jolt me back to life.

After the initial shock wore off, and the instant regret had sifted through my mind, I leaned to God. I asked him for one more chance. Just one more shot at a normal life. My mind filled with every emotion imaginable; fear, sadness, anger. As I drifted through the shallows, time stood still. I wanted to stand up and walk out of that water. I wanted to run to every family member and friend and tell them how much I loved them. But I couldn’t. Every few seconds, the Atlantic would swallow me up and spit me back out. Just as I thought all hope was lost, a miracle happened. Out of the corner of my eye, I saw the lifeguard rushing towards me. Henry, as I’ve come to learn, saved my life.

With the help of my friend, we battled through the waves and onto shore. I knew something was horribly wrong, but I didn’t know how bad it actually was. I thought that maybe I had a concussion or just a stinger. Without saying a word, the lifeguard’s pale faces said everything I didn’t want to know. In that moment, I knew it was bad. As I lay in the sand, unable to move a muscle, the shock subsided and the pain began. The burning and stabbing sensations started in the back of my neck and quickly spread throughout my entire body. My arms remained limp, but they began to prick and tingle. They felt like they were asleep, multiplied by a thousand. The nerves throughout my body were all firing, sending me into an alarming state of nausea. I tried to remain calm. I tried telling myself that everything would be fine. But, somewhere deep inside of me, way past the heart and mind, I knew otherwise. I knew that things would never be the same. I was loaded onto an ambulance and taken to the hospital in Atlantic City. As I laid on the gurney, my mind wrestled with the thought of paralysis. Why does this happen to people? Was this my fate?

“John, you’ve broken your neck. The good news is: you didn’t sever your spinal cord. The bad news is: you’re going to need immediate surgery. We’re going to cut through the front of your neck and drill out the broken bone. Then, we’re going to turn you over, take out the bone, and place a steel cage where the bone used to be located. We’ll place a metal plate over your entire spinal column, and hope the bones attach themselves to the man-made device. There could be complications. If something goes wrong, we will have to perform a tracheotomy, which wouldn’t allow you to speak for the rest of your life. If the bones don’t attach, your neck could break again from the slightest of movements. And if your body doesn’t react properly to the shock and trauma of the situation, you could go into cardiac arrest and die.”

The hospital room was dark and still. It was cold, but not unbearable. At the doctor’s request, my friends

had already said their tearful goodbyes. Sirens occasionally blared from a nearby window. I opened my eyes, cautiously staring upwards. My mind raced, but I remained calm. One minute, I found myself at peace with the situation, allowing the reality of my circumstance to filter through my lifeless body. The next, I was consumed with fear and anger. I tried not to think about the possibility of death, because I knew it was out of my control. But part of me felt dead already. When waiting on the doorstep of eternity, this is what the dead must envision: a hollow ending to a semi-meaningful life. My bed felt like a coffin, enclosing me from the rest of the world. The dead were left to rest this way, awaiting their judgement from the almighty above. In a way, I was also awaiting my judgement.

I had surgery the following morning. It lasted eleven hours, but I didn’t actually come-to for several days. Eventually, things got better. I was transferred to the ICU, where I began learning how to use my body all over again. I remained there for several weeks before gaining clearance into The Magee Rehabilitation Center in downtown Philadelphia.

In rehab, mornings came quickly. Nurses rushed through the center’s halls at all hours of the day/night. As it turns out, taking care of the disabled is a round-the-clock job. At the time, I believed nurses all had the same purpose; to pick, to pry, and to annoy. Most days, I found myself wide-awake by 7:00 am, unable to sleep through the constant commotion. If I said I wasn’t miserable, I’d be lying. But, after a few days, my mindset changed drastically. I was starting to use my hands and could take baby steps with the help of several nurses. At night, I’d lie in bed and think. I’d think about my friends and family, and wonder what my purpose in life really was. The thought of being paralyzed was terrifying, but after witnessing the hardships of the other patients, I knew it could have been much worse. I saw men, women, and children paralyzed from the neck down, moving their electric wheel chairs with a straw in their mouths. I’d sit in the cafeteria and watch these people visit with their families. I can’t imagine a pain worse than that. The pain I’d felt in the weeks previous doesn’t compare. That’s when it hit me. I was going to get through this. I was going to do anything I could to beat this injury. I had to beat it, not only for myself, but for my friends and family that were depending on me.

Some stories don’t have happy endings. Sometimes, our fate walks hand in hand with our demise. Thankfully, my story is still being written. But, this chapter ends on a positive note. You can’t go through life wondering if and when something bad will happen, but when it does, you react. That’s simply what I did. However, I wasn’t alone on my journey through Hell, and this story is for those people that helped along the way. This article is for my friends that drove eight hours through the night, just to sit in a waiting room to hear if I’d survived. And those same friends that gave up warm summer days, just to sit inside and visit with their disabled friend. It’s for my friends that saw me in that hospital bed the first night and the strength they showed me in the hardest of times. This article is for my family members that sat beside my bed, all day and all night, just making sure I was comfortable. It’s for those nurses that were only trying to help, and the doctors that spent countless hours putting me back together. I want to thank all of you. Without your love, I would be nothing. I’ve learned a lot from this experience, some good and some bad. But there’s one thing I will always take with me; sometimes bad things happen to us, and when they do, you see people’s true colors. You know who will always be there for you, and it makes your relationships even stronger. I may have been the blueprint for catastrophe, but the people around me turned this story into a miracle.

I’ve been to the brink. It’s located past the breaking point, on the doorstep of death. I have experienced more pain than most people can imagine. And yet, I’m still alive to write this. I’ve seen a glimpse into the horrors this life has to offer, and there’s nothing glorifying about it. There’s nothing glorious in lying on a hospital bed, unable to brush your own teeth or wave to say goodbye. Learning to stand again isn’t glorious, it’s torture. Going to rehab for years isn’t glorious, it’s Hell. I truly believe that we are shaped by the people around us, and the experiences we go through. We live our lives for moments that transcend time. This experience changed my life, for the better. It made me appreciate the small things and forced me to never take a day for granted.

2016

We recently “celebrated” the eight year anniversary of my accident. It’s a strange thing, looking back on the whole ordeal. I realize now just how fortunate I was and how much worse it could have been. By the grace of God, I can proudly say that I wrote this story with my own hands. The same hands that remained clenched in paralysis for months following the accident. At my mother’s request, I began writing in rehab. I’ve always

had a love for words and the pictures they can create. But, it wasn’t until my accident that I could take a step back and see the bigger picture. I began writing about my accident. It was physically therapeutic and mentally cathartic. I knew immediately that I had to get every memory on those pages as fast as possible, or it would become lost in the vast corners of my mind.

After months of rehab, I went back to college (with a conversation-starting neck brace) and got my bachelor’s degree in Liberal Studies. I tacked on a minor in Professional Writing, which I continue to use to this day. This short story is a small piece of a much larger novel portraying the entire situation. I currently work for the United States Government processing retirement cases for federal employees. On the side, I am a freelance writer, focusing on the novel and several other screenplays. Thanks to the surgeons, doctors, nurses, and physical therapists, I have absolutely no hindrance in my everyday life. I play basketball, tennis, lift weights, and behave as any normal 28 year old male would. Most people are completely shocked when they hear my story, because I don’t appear as someone who went through such trauma. And, the 11 inch scar that weaves down the back of my neck is usually hidden under my long black hair. My friends say that I don’t act any different, almost as if it never happened. Outwardly this may be true. But internally, I am grateful and thank God every day for giving me a second chance in this world.

March 8, 2017 John and Jenna Kaufman welcomed Beau Michael, their first child. The photo shows a beautiful baby and a very tired father who looks a bit overwhelmed! Sadly do not have a photo of the undoubtedly exhausted mother……Now for the most exciting journey of their lives – PARENTHOOD. (In full disclosure, John is the nephew of Kathleen Kaufman.)

A Patient’s Journey: Fracture

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