Page 1 Page 10 Page 7 · 2018-03-31 · made by Clair Jordan, Texas Nurses Association, 7600 Burnet Road, Austin, TX 78757. Join the Texas Nurses Association Today! Application on

Inside this IssueTNA Districts and Presidents . . . . . . . . . . . . 2

On the National Front: The 111th

Congress and the “Free Choice” Act . . 3-4

Unions 101 . . . . . . . . . . . . . . . . . . . . . . . . . 5

Using Nursing Shortage Data:

Aren’t the Pieces But Partial Truths? . . . 10

October TISWG Meeting . . . . . . . . . . . . . . 12

Lance Armstrong Foundation Awards

$150,000 Grant to Nurse Oncology

Education Program . . . . . . . . . . . . . . . . . 14

Nurses are Again Tops in

Honesty and Ethics . . . . . . . . . . . . . . . . . 16

Membership Application . . . . . . . . . . . . . . 18

A Nursing Legislative Agenda for TexasOn January 13, 2009, the Texas Legislature

convened for its 81st session. From January 13 through May 29, literally thousands of bills will be proposed for the consideration of legislators, with only about 25% of them actually being enacted. Texas Nurses Association (TNA) is an active participant in the legislative process with a track record of successfully passing about 75% of all its proposed legislation. TNA’s success is

largely attributable to its status as the recognized author i t y and voice for nursing in Texas, as well as its integrity as a professional association. TNA’s 2009 legislative initiatives will build on previous successful efforts t o i m p r o v e t h e p r a c t i c e

environment for nurses by strengthening existing regulations and introducing new protections. For an overview of nursing’s top 25 legislative accomplishments, see page 9.

Nurse Staffing Legislation FiledNurses who provide direct patient care in

Texas hospitals will gain even more influence in setting appropriate nurse-to-patient staffing levels, thanks to 2009 legislation filed January 14. The legislation authored in the Senate by Sen. Jane Nelson (R-Flower Mound), chair of the Senate Health and Human Services Committee, and in the House by Rep. Donna Howard (D-Austin), a former practicing registered nurse, requires hospitals to establish nurse staffing committees as a standing committee of its board of directors. Direct care nurses, selected by their peers, will comprise at least 50% of committee membership and the hospital’s chief nursing officer will sit on the committee. Committee members must be relieved of other work responsibilities during their participation in the meetings.

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Editors’ Note:Editors’ Note:Editors’ Note:Editors’ Note:Editors’ Note:Editors’ Note: With With

week or so. week or so.

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The nurse staffing committee will be responsible for recommending a unit-based, shift-based nurse staffing plan for the hospital based on nurse, patient, and hospital characteristics, as well as national standards. Nursing sensitive indicators for evaluating the plan will be determined by the committee. The committee will appraise the effectiveness of the staffing plan utilizing these indicators and data regarding staffing variations. This evaluation will be reported by the committee to the hospital board at least semi-annually. Additional accountability for nurse staffing is included in required hospital reporting to the Texas Department of State Health Services (TDSHS) regarding nurse staffing plans.

Page 2 • Texas Nursing Voice January, February, March 2009

TNA Districts and Presidents 1: Connie Barker Phone: 915/ 584-0051 Email: [email protected]: Paula Antognoli Phone: 806/351-5103 Email: [email protected]: Sandi McDermott Phone: 972/566-7187 Email: sandi.mcdermott@

hcahealthcare.com District Staff: Renee James Phone: 817/249-5071 Email: [email protected] Web site: www.tna3.org4: Colleen Hines Phone: 972/348-1614 Email: [email protected] District Staff: Pat Pollock Phone: 972/435-2216 Email: [email protected] Web site: www.tnad4.org5: Kim Belcik Phone: 512/990-8987 Email: [email protected] Web site: www.tna5.org6: Ellarene Duis Phone: 409/772-8390 Email: [email protected] Web site: www.tna6.org7: Megan Mosley Phone: 254/760-8548 Email: [email protected] Web site: http://www.tnadistrict7.org/8: Gayle Dasher Phone: 210/705-6266 Email: [email protected] Web site: www.texasnurses.

org/districts/08/

9: Mary Holt Ashley Phone: 832/566-2010 Email: [email protected] District Staff: Melanie Truong Phone: 713/523-3619 Email: [email protected]

Web site: www.tnadistrict9.org10: Barbara Hills Phone: 254/420-1231 Email: [email protected]: Connie Beddingfield Phone: 940/521-5406 Email: cbeddingfield@

grahamrmc.com12: Patricia Morrell Phone: 936/212-7222 Email: [email protected]: Vacant 14: Joe Lacher Phone: 956/882-5089 Email: [email protected]: Andrea Kerley Phone: 325/670-4230 Email: [email protected] Web site: www.texasnurses.

org/districts/15/16: Martha Sleutel Phone: 325/942-2060 ext. 258 Email: [email protected]: Nancy Goodman Phone: 361/825-2607 Email: [email protected] Web site: www.texasnurses.

org/districts/17/

18: Patty Freier Phone: 806/797-8120 Email: [email protected] Web site: www.texasnurses.

org/districts/18/19: Nina Wallace-Gross Phone: 903/877-5102 Email: [email protected] Web site: www.texasnurses.

org/districts/19/20: Kathleen Elliott Phone: 361/552-3063 Email: [email protected]: Sherrie Harris Phone: 432/381-2429 Email: [email protected]: Toni McDonald Email: [email protected]: Shirley Aycock Phone: 903/646-3745 Email: [email protected]: Carolina Huerta Phone: 956/383-7365 Email: [email protected]: Kim Penny Phone: 903/832-5565 ext. 3205 Email: [email protected]: Sally Durand Phone: 281/756-3634 Email: [email protected]: Contact TNA Phone: 800/862-2022 ext. 129

TEXAS NURSING Voice A publication of Texas Nurses Association

January, February, March 2009Volume 3, Number 1

Editor-in-Chief — Clair B. Jordan, MSN, RNManaging Editor — Joyce Cunningham

Creative Communications — Deborah TaylorCirculation Manager — Belinda Richey

Editorial ContributorsJoyce Cunningham; Laura Lerma, MSN, RN;

Jim Willmann, JD; and Cindy Zolnierek, MSN, RN

Editorial Advisory Board Stephanie Woods, PhD, RN, Dallas, (Chair)Jose Alejandro, MSN, RN, MBA, CCM, DallasPatricia Allen, EdD, RN, CNE, ANEF, Lubbock

Sandra Kay Cesario, PhD, RN, C, PearlandJennifer D.M. Cook, PhD, MSN, RN, San Antonio

Anita J. Coyle, PhD, RN, CHES, SangerThelma L. Davis, LVN, Giddings

Anita T. Farrish, RN, MHSM, NE-BC, WacoPatricia A. Goodpastor, RN, The WoodlandsPatricia Holden-Huchton, RN, DSN, Denton

Tara A. Patton, BSN, RN, PalestineDianna Lipp Rivers, RN, CNAA, BC, Beaumont

Executive Officers Susan Sportsman, PhD, RN, TNA President

Margie Dorman-O’Donnell, MSN, RN, TNA Vice President

Rebecca Krepper, PhD, MBA, CNAA, TNA Secretary-Treasurer

Regional Directors of Texas Nurses AssociationKleanthe Caruso, MSN, RN, CNAA, CCHP —

North RegionJennifer D.M. Cook, PhD, MBA, RN — South RegionDana Danaher, MSN, RN, CPHQ — Central Region

Viola Hebert, MA, BSN, RN — East RegionJo Rake, MSN, RN — West Region

Executive DirectorClair B. Jordan, MSN, RN

TEXAS NURSING Voice is published quarterly — October-November-December, January-February-March, April-May-June, and July-August-September — by Texas Nurses Association, 7600 Burnet Road, Suite 440, Austin, TX 78757-1292.

Editorial Office: TEXAS NURSING Voice,7600 Burnet Road, Suite 440, Austin, TX 78757-1292512.452-0645, E-mail: [email protected]

Address changes:Send address changes to Texas Nurses Association, 7600 Burnet Road, Suite 440, Austin, TX 78757-1292

E-mail: [email protected]

Advertising:Arthur L. Davis Agency, 517 Washington St.

P.O. Box 216, Cedar Falls, Iowa 50613319.277-2414, E-mail: [email protected]

Texas Nurses Association and the Arthur L. Davis Publishing Agency reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.

Acceptance of advertising does not imply endorsement or approval by Texas Nurses Association (TNA) 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. TNA and the Arthur L. Davis Publishing Agency 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 the views of the staff, board, or membership of TNA or those of the national or local associations.

Copyright © 2009 by Texas Nurses Association.

January, February, March 2009 Texas Nursing Voice • Page 3

The New Year will welcome a new president and congress to Washington with challenges nothing short of crises — from the economy to healthcare. A key labor bill, known as the “Free Choice” Act, which failed to pass the senate in 2007 is expected to be reintroduced in 2009. With the democratic majority, and President-elect Obama’s promise of support, it has a great likelihood of passing.

So what is the “Free Choice” Act? And why is it important for nurses to be informed?

The “Free Choice” Act has been called the most significant and fundamental proposed change to labor law since the 1935 National Labor Relations Act. The Act would eliminate secret ballot elections and instead set forth a card check process making it much easier for unions to organize. As blue collar jobs have declined, unions have directed organizing efforts toward the rapidly growing healthcare market. Nurses have been specifically identified as a strategic target for unionization (Registered Nurse Unionization, 2005, UAN). Therefore, nurses need knowledge about how proposed changes may affect their workplace and their practice so they can make informed choices.

To understand the “Free Choice” Act, it helps to have a general understanding of the existing process for unionization (see Table I). The “Free Choice” Act eliminates the secret ballot process that currently exists and instead

On the National Front: The 111th Congress and the “Free Choice” Act

enables a union to petition the National Labor Relations Board (NLRB) for recognition when 50% plus one employee have signed authorization cards. Further, the Act mandates binding arbitration if a union and organization are unable to agree on a contract within 120 days.

Opponents express concerns that, by eliminating secret ballot elections, the Act violates a fundamental right of employees to freely express their desire to join or not join a union without intimidation or fear. In addition, reaching agreement on an initial contract within 120 days is not usual, and an arbitrator may not be in a position to establish conditions that enable an organization to remain competitive and marketable.

Proponents say that a simple majority card check process will make it easier for employees to form unions without harassment from employers. Binding arbitration is needed to prevent employers from tactics to delay bargaining.

Numbers of unionized workers have steadily declined over the past 50 years. In the 1950s, over 35% of persons employed in the private sector belonged to unions. Today that number is 7.5%, or 12% if you include the public sector (governmental employees). While jobs in the traditionally union blue collar sector have declined, employment in healthcare continues to demonstrate strong growth that is expected

to continue despite the economy woes. The growth of RNs within the healthcare workforce has skyrocketed. With respectable wages and solid employment, they become a natural strategic target for unions seeking to grow membership and dues income.

Nurses make life and death decisions every day and appreciate the importance of having the correct information before making those decisions. Any choice needs to be an informed choice to be “free.” Be informed!

Continued on page 4


Continued from page 3

TABLE I: The Union Organizing Process

STEPS PrOcESS “FrEE chOIcE” AcT

1. Strategy, Targeting, and Initial Contact

2. Building Support

3. Card Signing

4. NLRB Filing

5. Secret Ballot Election

6. Votes Certified by NLRB

7. If Union Elected…

Election of Stewards and Negotiating

Committee

In the past, unions were formed when groups of employees, dissatisfied with

their working conditions, formed an organizing committee and either established

their own union or approached a union to represent them. Unionization was initi-

ated from within the organization.

More common today is the initiation of efforts from outside the organization –

e.g., the union strategically targets a particular industry (such as health care or

nursing) and/or an organization (such as a hospital or health care system) and

recruits members directly.

Health care has also experienced the introduction of unions through neutral-

ity agreements whereby the organization signs a binding agreement to allow a

particular union exclusive rights to solicit employees within the organization

without interference or opposition from the organization or other unions. Such

a situation currently exists between Tenet HealthCare Corp. and the National

Nurses Organizing Committee of the California Nurses Association (NNOC/

CNA).

NNOC/CNA entered certain Tenet facilities to promote collective bargaining, not

at the request of employees who were interested in unionizing, but because of a

contract signed between Tenet and NNOC/CNA. Such contracts are usually the

result of outside pressures from the union through key stakeholders.

Once contact is established, the employee organizing committee and/or the

union, build support for the union. This is essentially a sales process in which the

union attempts to “sell” employees on the benefits of membership.

The union will distribute authorization cards for employees to sign. By signing

an authorization card, the employee is indicating their interest in a particular

union and requesting a formal vote.

Once at least 30% of employees sign an authorization card, the union can peti-

tion the National Labor Relations Board (NLRB) for an election. Elections are

usually held within 39 days of the NLRB’s receipt of the cards.

Union elections are supervised by the NLRB in a designated polling area, usu-

ally at the worksite. Each party, that is the union and the employer, are allowed

a certain number of observers. Key to election process is the right of each em-

ployee to cast a secret ballot.

A simple majority of those voting (not necessarily all employees) -- 50% plus

one -- determines the outcome of the election. If the union achieves a majority

vote they petition the NLRB for certification as the recognized union.

If a union is elected, a committee will be selected to negotiate a contract with the

employer. An initial contract begins as a “blank slate” – while employees may

have enjoyed certain wages and benefits prior to electing a union, everything is

up for negotiation once a union is recognized. No one can predict the outcome

of contract negotiations as it is a give and take process.

Card Check

By signing a card, the employee casts a vote

for the union.

Step deleted

Step deleted

Once a simple majority of employees sign

cards, the union can petition NLRB for certifi-

cation as the exclusive agent of employees.

If a contract is not negotiated within 120 days,

binding arbitration is mandated.


Nurses in Texas have been targeted for union organizing. While it can be agreed that each individual nurse has the right to determine whether collective bargaining is the right workplace approach for them, Texas Nurses Association believes it is always advisable to access as much information as possible with which to make informed decisions. The following facts are offered to assist nurses in making informed choices.

Unions are businesses.A union is basically a business that provides a

service for the price of membership. The service provided is representation of employees to the employer; the union becomes the agent of the employee group. In many ways, this is not unlike contracting with a realtor or an attorney for representation in personal business. However, one significant difference is that a union represents an employee group — NOT individuals. The union’s “client” is the employee group and the focus will be on the preferences of the majority, NOT the preferences of an individual.

Representation and services cost money so membership dues are charged. Dues vary by union, but can be significant. Unions in the U.S. are big business with 15.4 million members (about 12% of workers), over $1 billion in collected dues revenue, and leaders with six-figure incomes.

Collective bargaining means collective treatment.

A union is selected by a majority vote of employees casting secret ballots, although this current process could change with Congress’ passage of the “Free Choice” Act (see related

article, page 3). Once the election outcome is ratified (formally approved and sanctioned) by the National Labor Relations Board (NLRB), the union becomes the agent for the entire employee group — whether the individual voted for the union or not.

When a union is voted in as the agent for the entire group of employees, individual rights of an employee to discuss or negotiate terms and conditions of employment (such as hours, schedule, position, merit increases, etc.) are exchanged for terms negotiated in a contract which would then apply to the entire employee group. For example, practices of working out scheduling needs with one’s co-workers and manager may be over ridden by scheduling rules of the contract. Often, across-the-board wage rates replace merit pay for performance plans.

Promises are not guarantees.When a union is elected, one’s individual

employment agreement will be replaced with a contract covering the employee group. The contract generally covers wages, benefits, and conditions of employment and must be negotiated from scratch. While employees may have enjoyed certain wages and benefits prior to electing a union, once a union is recognized, everything is up for negotiation. The final contract may offer employees more, less, or the same conditions as before the union. Neither management nor the union can predict or guarantee the outcome of negotiations.

To be informed… know what you already have.

If you are considering joining a union, it’s always advisable to consider what it may be able to provide that you don’t already have.

Unions 101Many health care organizations currently have competitive wages and benefits, desirable workplace conditions (such as hospitals with Magnet® or Pathway to Excellence™ designations), shared governance or participative management structures, and positive relationships among management and staff.

Unlike some states, all nurses in Texas currently have:

• Whistle-blower protections — nurses cannot be retaliated against for reporting concerns about another practitioner, staffing, and patient care/safety, or for refusing to engage in reportable conduct.

• Staffing regulations — hospitals must consider the effectiveness of staffing plans on nurse-sensitive patient outcomes regardless of nurse-to-patient ratios.

• Safe patient handling laws.

• Regulations protecting nurses from harassment and abuse in the workplace.

Unions can provide a mechanism for collective action when employees feel that their individual efforts have been ineffective. A union serves as a third party, or agent, of the employees to represent collective, not individual, interests. The conditions they are able to negotiate become the contract that typically governs work conditions, wages and benefits. Negotiation is an uncertain process of give and take — there are no assurances of what the final contract will provide. Informed choices can only be made by informed nurses. ★

When it comes to the overall health of Americans, not much improvement has occurred other than the rankings of whose citizens are considered healthy and whose are not. Texas is among the not. It ranks number 46 on the list of 50 healthy states; just four slots above the worst ranked state of Louisiana, and a disappointing 45 slots below the healthiest — Vermont.

In the 19th annual state-by-state ranking announced in early December and put together in a report of the American Public Health Association, the United Health Foundation, and the Partnership for Prevention advocacy group, a series of measures is used in the assessment including infectious disease rates, immunization coverage, air pollution, health insurance coverage, crime levels and even binge drinking. The assessment has Texas joining nine other states in making up the bottom 10 of the least healthy places to live — Georgia (#41), Nevada (#42), Arkansas and Oklahoma (tie for #43), Florida (#45), Texas (#46), Tennessee (#47), South Carolina (#48), Mississippi (#49) and Louisiana (#50).

The 10 states on the bottom of the list have some of the highest rates of obesity, and consequently stroke, heart disease, diabetes, and some forms of cancer. Those states according to the report had high rates of smoking, high child

Texas Among 10 Unhealthiest U.S. States

poverty, infant mortality, premature death rate, and cancer deaths.

And the opposite end, Vermont topped the rankings as the healthiest state in the nation. With an obesity rate of 22 per cent — 4 points below the national average — Vermont had the third-highest public health spending of any state. And the report revealed, low child poverty and violent crime, and strong high school graduation rates.

Following Vermont at the top were Hawaii, New Hampshire, Minnesota, Utah, Massachusetts, Connecticut, Idaho and Maine. ★


Why Staffing Plans?A dictionary offers the following

definition for staffing: “to provide with a staff of workers.” It sounds simple, but nurse staffing for safe patient care is complex and requires flexibility in the matching and providing of staff resources for patient care requirements — balancing resources and needs (see Individualized Patient Staffing Model, at above right).

Who is doing what?• Mandated fixed ratios: Currently only

California has implemented this approach

• Seven states have mandated staffing plans (Texas, Oregon, Rhode Island, Illinois, Connecticut, Washington, Ohio)

TNA believes that patients do best when direct patient care nurses are allowed to use their own judgment on the level of care their patients need. Nurse staffing committees allow nurses to use their own best judgment and allow the flexibility necessary in the dynamic acute care hospital environment.

Mandatory Overtime ProhibitionIncluded in the Nurse Staffing Legislation is

a provision to prohibit mandatory overtime in hospital settings. Mandatory overtime is defined as being required to work beyond hours or days scheduled, but does not include time

The proposed legislation requires that the hospital implement a process for educating and encouraging nurses to provide input to the nurse staffing committee regarding staffing concerns. Nurses are protected from retaliation for providing such input. The hospital must also make the staffing plan and the current staffing levels available to nurses on each patient care unit, each shift.

This legislation wraps around existing hospital licensing rules which currently require hospitals to have advisory staffing committees and staffing plans, significantly elevates the role of staff nurses in participating in the development and evaluation of the plan based on patient assessments. Further, the committee is directly linked to the hospital board of directors. In addition, by requiring hospitals to report to TDSHS, hospitals must assume a new level of accountability. The passage and enactment of this legislation will be a definitive win for Texas nurses.

Continued from page 1

immediately before or after a shift (e.g., report time). Voluntary overtime is not affected and overtime compensation is not affected. Refusal to work mandatory overtime would not be considered patient abandonment. TNA has long acknowledged the impact of fatigue on nurses’ vulnerability to make errors, fail to prevent errors, and to become injured. In addition, mandatory overtime ignores nurses’ obligations apart from the work setting (e.g., child or elder care responsibilities) and general work/life balance. This legislation protects patients and honors the needs of the nurse.

Waiver of Sovereign Immunity Sovereign immunity protects the state from

civil suit or criminal prosecution; it is based on the doctrine that the state can do no wrong. Waived sovereign immunity overrides this doctrine and enables a party to sue the state. Currently, Texas has waived sovereign immunity for both state and local governments for certain activities, such as whistle blowing by public employees. However, these protections are not nearly as broad as those provided nurses in the Texas Nursing Practice Act (NPA) and other regulations. A recent court ruling determined that NPA protections are not specific enough to apply to publicly employed nurses who are retaliated against for reporting patient care concerns.

In response to this ruling, the legislation will provide publicly employed hospital nurses with the same rights as those employed in private hospitals if retaliated against for reporting patient care concerns. While whistle-blower protections cannot prevent retaliation, they can discourage it by providing remedies if retaliation occurs. Remedies for a nurse who has been retaliated against include damages (actual, including mental anguish, and punitive), court costs, attorney’s fees, reinstatement, severance pay, and/or compensation for lost wages. To access the remedies, the nurse must file a lawsuit. If the alleged retaliatory action occurs within 60 days of the nurse’s whistle blowing, the burden of proof shifts from the nurse (proving that the hospital’s action was retaliatory) to the hospital (proving that its action was independent of the nurse’s reporting).

Continued on page 7


Continued from page 6 Nursing Shortage: Appropriations Request

Texas Nurses Association has worked closely with other stakeholders including the Texas Hospital Association, universities and schools of nursing, and business groups to develop a proposal for the legislature to nearly double the number of nursing graduates in 2013. The stakeholder group — named the Texas Nursing Workforce Shortage Coalition — will request an appropriation of $60 million in addition to the current $14.7 million funding of the Professional Nursing Shortage Reduction Program to enable nursing schools to increase capacity and improve efficiency in the education and graduation of nurses. For more details and a list of coalition members, please see page 8 or visit www.texasneedsnurses.org.

Texas Public Health CoalitionCreated in 2006, the Texas Public Health

Coalition is a collection of organizations that share an interest in advancing core public health principles at the state and community levels. TNA will support the identified legislative priorities of the Texas Public Health Coalition such as improving immunization, increasing tobacco prevention and smoking cessation, and reducing obesity.

Continued on page 8


Continued from page 7 Nursing Legislative Agenda Coalition

In addition to its own legislative initiatives, TNA hosts a series of meetings with other nursing organizations prior to each legislative session to identify significant nursing and health care related issues that the Texas Legislature needs to address. These organizations make up the Nursing Legislative Agenda Coalition (NLAC). Once NLAC has identified the legislative issues on which nursing should focus, it works to achieve a consensus of opinion on what the coalition's position will be on each issue. The result of this process is the Nursing Legislative Agenda and during the session, coalition members endorse and work to enact the agenda. NLAC also serves as a body to build a unified nursing position on other legislation important to nurses and their patients.

NLAC’s legislative agenda for 2009 includes:

• Support the Texas Nursing Workforce Shortage Coalition appropriations request to increase the numbers of registered nursing graduates.

• Support legislation to improve the nurse’s practice environment including mandated staffing plans, elimination of mandatory overtime, and waiver of sovereign immunity.

• Support for advanced practice nursing’s efforts to remove artificial restrictions and enable APNs to practice within the full scope of their competency.

• Support efforts to increase numbers of school nurses and improve school health including legislation requiring school districts to inform parents if their child’s school campus has a school nurse assigned to it.

• Oppose substitution of nurses by other personnel when the broad generalist preparation of a nurse best promotes safe patient care.

Continued on page 9


Continued from page 8Nursing Legislative Agenda Coalition

The following 21 nursing organizations are members of the Nursing Legislative Agenda Coalition:

Texas Emergency Nurses Association

Texas Organization of Associate Degree Nursing

Association of Women’s Health, Obstetrics & Neonatal Nurses

Society of Otorhinolaryngology & Head & Neck Nurses — Houston

Texas Nurse Practitioners

Texas Association of Vocational Nurse Educators

Texas Association of Deans and Directors of Professional Nursing Programs

Texas Organization of Baccalaureate & Graduate Nurse Educators

Texas RN First Assistants Network

Association of periOperative Registered Nurses

Houston Organization of Nurse Executives

Licensed Vocational Nurses Association of Texas

Texas Nursing Students’ Association

Nursing Education Policy Coalition

Texas Association of Vocational Nurse Educators

Coalition for Nurses in Advanced Practice

Texas Association of Nurse Anesthetists

Texas Council of periOperative Registered Nurses

Texas Organization of Nurse Executives

Texas School Nurses Association ★

• A d v o c a c y a n d w h i s t l e b l o w e r protections: nurses have the right to advocate for patients, the right to request safe harbor peer review, the right to refuse to engage in conduct believed to violate a nurse’s duty to patient, the right to report concerns, and protection from poor employee reference when refusing to engage in conduct believed not in the patient’s best interest (1987, 1995, 1997, 1999, 2003, 2005, 2007).

• Nurse staffing: hospital licensing rules requiring input from staff nurses, written staffing plans evaluated on nurse sensitive outcomes, policies on mandatory overtime and floating (2001, 2007).

• Safe patient handling and workplace safety: Texas had first-in-the-nation legislation requiring policies minimizing manual lifting and addressing violence and workplace safety (2003, 2005).

• Nursing shortage: over $55 million has been secured for nursing schools to increase enrollments, establishment of Center for Nursing Workforce Studies that researches nursing supply and demand, a $500 tuition exemption for preceptors and their children (2001, 2003, 2005, 2007).

• Unified regulation of nursing: there is now a single Board of Nursing (BON) and practice act for RNs and LVNs (2003).

• Licensure mobility: Texas now participates in the Nurse Licensure Compact (1999).

• Regulation of nursing education: BON has authority over nursing education (1981, 2007).

• Nurse title protection: use of the title “nurse” is limited to RNs and LVNs (1999, 2003). Other industries had attempted to use the word “nurse.”

• Nursing peer review: a nurse is afforded due process when being reviewed, system issues rather than individual blame are considered, and may not need to be reported to BON (1987, 1993, 2007).

• Peer assistance: nursing has a peer assistance program to support safe return to practice for nurses with mental illness or chemical dependency (1987).

• Practice protection: allied health groups have not been able to exclude nurses from performing functions that overlap with allied health group (1981-2003).

• Declaring death: RNs have authority to declare death (1991).

• Diabetic management: RNs are able to do nutritional and pharmaceutical component s of diabetes sel f -management training (1999).

• Specific-subject CNE and curricula: nurses are not required to take specific subjects.

• Personal protection: nurses have the right to obtain test results of a patient tested for Hepatitis C or HIV after an accidental exposure (1999).

• Occupational tax: nurses are exempted from paying an annual occupational tax as required of most other professionals (1989).

• Apparel choice: nurses are able to wear scrubs outside of the clinical area (1999).

• APN prescriptive authority: ability of APNs to prescribe (1989, 1995, 1997, 2001, 2003).

• APN reimbursement: APNs are able to bill Medicaid and insurance companies for reimbursement (1992, 1999).

• APN clinical privileges and scope of practice: APNs are guaranteed due process in seeking clinical privileges (1999, 2003).

• RN first assistants and circulating nurse: insurance companies cannot discriminate against RN first assistants; the circulating nurse must be an RN (2001).

• School nurses: have the same contractual rights and same minimum salary scale as other school employees (1995, 1999).

• Nursing home supervision: Director of Nursing in nursing homes is required to be an RN (1997).

• Unlicensed personnel: prohibits physicians from bypassing the RN and delegating the administration of medications directly to unlicensed personnel in home health (1997).

• 100+ years of advocacy for nurses!

25 Legislative Accomplishments for Nursing in Texas

TNA has been at the Texas Capitol advocating for nurses for over 100 years.Here are the top 25 legislative accomplishments which form a solid foundation for continued efforts to improve the practice environment for nurses.

It Pays to be Surveyed

When editors of the TEXAS NURSING Voice asked readers in the July/August/September issue to help us out by taking a Readership Survey, you did. And for those who did, we thank you.

Following the actual survey, we gave survey takers the opportunity to win one of two $50 Visa® Gift Cards. We’re happy to report that the gift cards were won by Luis Decker, an LVN from Laredo, and Kim Belcik, an RN from Austin. Congratulations to our winners and thanks to all of those who participated. ★


by Cindy Zolnierek, MSN, RN

Most of us have heard the story of the blind men and the elephant. In case you need a refresher:

Six blind men were to examine an elephant and then describe the animal. Each man touched a different part of the elephant to determine what it was like. The man who touched the tail said it was like a rope; the one who touched the trunk, a tree branch; the foot, a pillar; the tusk, a solid pipe; the ear, a fan; and so on. The men begin to argue about their very different findings. A wise man tells them that they are each right in their description, but that each is incomplete in that they only touched a part of the whole.

Each of the men had a correct bit of information, however, without being considered together, the data could not offer a valid description of the elephant. Only when the data was integrated in context, could a complete and accurate description emerge. The same holds true for other kinds of data, particularly nursing shortage data.

In general, we look to data to provide us with information from which we can make informed decisions. Many nurses are familiar with evidence-based practice in which nurses inform themselves about best practices (those shown to accomplish the best patient outcomes) and then pattern their own practices, policies, and procedures after those shown (through data from quality assurance and performance improvement activities, published studies, etc.). We rely on valid and accurate information to guide us.

We assume numbers to be objective and, therefore, unbiased, believable and “true.” However, even when reported numbers may be technically correct (as were the touches of the blind men), their interpretation and implied conclusion may be entirely faulty depending on how and which numbers are reported. Incomplete or misleading figures can lead to grossly inaccurate conclusions. Partial data tells partial truth.

Recently, the media has reported data as “facts” about the effects of mandated nurse-to-patient ratios on the nursing shortage in California. Unfortunately, these reports are more like the blind men’s descriptions than a true picture of the elephant. Conclusions based on incomplete data cannot be correct and are likely to result in decisions that fail to achieve desired outcomes. ★

Using Nursing Shortage Data: Aren’t the Pieces But Partial Truths?

Partial Data The Facts

CLAIM 1: 86,000 California RNs Facts 1:returned to nursing since the • The number of actively licensed RNs in Californiaratio bill was passed in 1999.1 increased by 85,975 from June 30, 1999 to January 1, 2008 — a 34.9% increase.2 This is NOT the number of RNs returning to nursing, but rather an increase in total number of licensed (e.g., increase in graduates).

• Texas experienced a similar increase of actively licensed RNs — 36.3% — during the same period, without mandated ratios.3

CONCLUSION 1 — The increase in actively licensed RNs in California since 1999 is, proportionately, slightly less than the increase experienced in Texas for a similar time period. There is no evidence that the ratio bill returned nurses to nursing.

CLAIM 2: If Texas adopted ratios, Facts 2: • The percentage of actively licensed California RNs who do not work in nursing was 17.3% in 2004.4

• The US percentage was 16.8%.4

• The percentage in Texas was 13.7%.4

• Pharmacy has a similar percentage (US 14%) of actively licensed individuals that do not practice in pharmacy.5

CONCLUSION 2 — Despite mandated ratios, California has a lower percentage of nurses employed in nursing than the national average and lower than Texas, a state without mandated ratios.

CLAIM 3: Data proves mandated Facts 3:RN-to-patient ratios improve • Data consistently supports a positive relationship betweenpatient outcomes.1 nurse staffing and patient outcomes. 6, 7

• No published studies have demonstrated that mandated ratios improve patient outcomes.

• The one published study that looked specifically at California ratios showed no differences in patient outcomes after ratios were implemented.8

CONCLUSION 3 — Adequate RN staffing is required for positive patient outcomes, however the approach for accomplishing adequate staffing, e.g. mandated fixed ratios or a mandated staffing plan, has not been determined by research.

CLAIM 4: Texas nurses have Facts 4: As patient advocates, Texas nurses are uniquely protected: • Safe Harbor protects nurses from action against their license as well as from retaliation by the employer.10

• The Texas Nursing Practice Act protects nurses from retaliation for:

• Refusing to engage in reportable conduct

• Reporting a patient care concern

• Reporting a practitioner or facility for exposing a patient to harm11

• Texas hospital licensing rules offer protections to nurses who report staffing concerns.12, 13

No law can completely prevent retaliation. Existing Texas regulations strongly discourage retaliation and provide remedies to nurses if they are retaliated against (civil lawsuit for damages, presumption of retaliation if occurrence is within 60 days of nurse’s action).

CONCLUSION 4 — Texas nurses have both patient advocacy rights and some of the strongest whistleblower protections in the country.

actively licensed RNs who are unemployed or not employed in nursing, would return to bedside nursing.1

no rights as patient advocates and no real whistleblower protections.9

References1. The Ratio Solution: CNA/NNOC’s RN-to-Patient

Ratios Work — Better Care, More Nurses, (2008), California Nurses Association/National Nurses Organizing Committee, accessed 12/12/08 from http://www.calnurses.org/assets/pdf/ratios/ratios_booklet.pdf.

2. California Board of Registered Nursing, http://www.rn.ca.gov OR California Nursing Workforce 2007, California Institute for Nursing & Healthcare, accessed 12/12/08 from http://www.cinhc.org/documents/CANursing Workforce2007.pdf ???

3. Texas Department of State Health Services, Health Professions Resource Center shows the number of Texas-licensed RNs with an active license who reside and practice in Texas increased from 119,074 as of September 1999 to 162, 304 as of September 2008 — and increase of 43,230 or 36.3% over the 9 year, 0 month period. Information accessed on 12/12/08 from http://www.dshs.state.tx.us/chs/hprc/tables/ 08RN.shtm

4. Bureau of Health Professions. 2007. The Registered Nurse Population: Findings from the March 2004 National Sample Survey of Registered Nurses. Washington, DC:

Bureau of Health Professions, Health Resources and Services Administration, U.S. Department of Health and Human Services, accessed on 12/12/08 from http://bhpr.hrsa.gov/healthworkforce/rnsurvey04.

5. National Pharmacist Workforce Survey (2005), Midwest Pharmacy Workforce Consortium, accessed on 12/12/08 from http://www.aacp.org/Docs/MainNavigation/Resources/7295_final-fullworkforcereport.pdf

6. Kane, R. L.; Shamlivan, T. A.; Mueller, C.; Duval, S.; Wilt, T. J. (2008). The association of registered nurse staffing levels and patient outcomes: systematic review and meta-analysis. Medical Care, 45(12):1195-1204.

7. Unruh, L. (2008). Nurse staffing and patient, nurse, and financial outcomes. American Journal of Nursing, 108(1): 62-71.

8. Bolton, L. B.; Aydin, C. E.; Donaldson, N.; Brown, D. S.; Sandhu, M.; Fridman, M.; & Aronow, H. U. (2007). Mandated nurse staffing ratios in California: a comparison of staffing and nursing-sensitive outcomes pre- and postregulation, Policy, Politics, & Nursing Practice, 8(4) 238-250.

9. CNA/NNOC flyer10. Texas Safe Harbor Nursing Peer Review, Nursing Peer

Review Law, Occupations Code, §303.00511. Texas Nursing Practice Act, Occupations Code,

§301.352 and §301.4025.12. Texas Health and Safety Code, §161.134.13. Texas Department of State Health Services Hospital

Licensing Rule §133.41(o)(2)(I) and §133.43.


w w w . t e x a s n u r s e s . o r g

another overtime shift, another three energy drinks.

“There aren’t enoughcaffeinated energy drinks in the world to get me through the overtime I have to work. Instead of limiting hours, they want to lecture us on fatigue.”

t n a ’ s c o n n e c t e d , s o y o u d o n ’ t h a v e t o b e w i r e d .

t oo much over t ime isn ’ t s afe for nurses or their patients. That’s why in

2001, TNA negotiated hospital staffing rules to improve the practice environment, including

policies to limit or eliminate mandatory overtime and floating. Built by Texas nurses for Texas

nurses, no other organization knows how to lobby for change in the Texas Legislature like TNA.

After all, we’ve been doing it for more than 100 years.


by Laura Lerma, MSN, RN

The Texas Immunization Stakeholder Working Group (TISWG) met October 16th, 2008; in Austin. TISWG was established to focus on improving the state immunization rates of Texas children. TISWG brings together, under the Immunization Branch of the Department of State Health Services (DSHS), a partnership of various agencies to set priorities and implement plans to increase the vaccination coverage rates across the state. Members of the working group represent federal, state and local health agencies and programs; schools; health care providers; employers; insurance/health plans; vaccine manufacturers; and partners from the private sector.

During the October meeting, attendees focused on: (1) The Immunization Branch’s strategic plan; (2) Planning for Influenza; (3) the adolescent/adult immunization business plan; and the results of the 4th dose Diphtheria, Tetanus, and acellular Pertussis (DTaP) vaccine research study.

Strategic PlanTime was spent reviewing the strategic plan

of the Immunization Branch and discussing the complexity of the Texas Immunization System. The vision of “a Texas that is free of vaccine preventable diseases” was discussed in light of the immunization process core elements, the need for governance and funding, the continued need for local and state support through DSHS, and the success of coalitions and partnerships like TISWG. The success of a Texas virtually free of measles, mumps, and rubella and almost free of Hepatitis A and Hepatitis B was celebrated. The need to continue to work in the areas of pertussis and influenza was reinforced.

Planning for InfluenzaWith influenza cases on the rise, an update

on influenza planning was timely. It is estimated that 5 to 20% of the population contract the flu every year leading to approximately 36,000 deaths and 200,000 hospital admissions across

the U.S., and costs a total national, economic burden of approximately $87 billion. Therefore, influenza plan or road map over the next five years, will serve as an educational tool for the public concerning influenza and the importance of the influenza vaccine. It will also identify those challenges that will be faced by the state of Texas as immunization stakeholders consider implementing the Centers for Disease Control & Prevention’s (CDC) recommendation of universal flu vaccine for all children from ages 6 months to 18 years. The roadmap also includes a list of recommendations developed by immunization stakeholders that address these challenges. Examples of the issues addressed among these recommendations include the following: Partnerships, public and provider education, including the use of educational tools for the public, vaccine supply and pricing, vaccine distribution and delivery, and partnering and working with schools, vaccinating “every child every year.”

Adolescent/Adult Immunization Program Business Plan

The development of an Adolescent/Adult Immunization Business Plan continues. The plan has narrowed down all the information that has been gathered into nine key elements:

1. Determining vaccine coverage levels,2. Educating stakeholders on adolescent

immunization program presences, goals and objectives,

3. Developing educational strategies for providers and the public

4. Ensuring resources are available,5. Promoting provider recruitment for both

ImmTrac and TVFC,6. Promoting provider education,7. Promoting public education,8. Promoting and developing alternate

vaccination sites, and9. Identifying and developing stakeholders.Tentative action plans have been developed

for each of the key elements. Feedback is being solicited from key stakeholders, like TISWG, in an effort to finalize the plan.

Fourth Dose DTaP Research StudyNational trends indicate that Texas is

improving in its vaccine coverage rate. The 4th DTaP is still a weak area as Texas is ranked 22nd by the National Immunization Survey on successful age appropriate completion of the 4:3:1:3:3:11 vaccine series. Meeting the national goals remains important as levels of pertussis are increasing in Texas with three (3) infant deaths reported this year.

Because the 4th DTaP statistics are of such concern on a statewide basis, and because it is one of the 2008 TISWG initiatives — along with adolescents immunizations and influenza; DSHS has been conducting a research study on parents’ perceptions regarding the 4th dose of DTaP. Both qualitative and quantitative data have been collected. In talking with parents, some interesting demographics and dynamics have emerged that contribute to them not having their child vaccinated with the 4th dose of DTaP. Barriers to getting the vaccine included: lack of insurance, limited parent knowledge related to access and the vaccine status of their child, an inability of the parent to get off work to take their child in for the 4th vaccine, and the need for a reminder of when the vaccine is due. The next step from this research is to determine action steps to address these barrier issues.

Other Immunization items of Interests

Hurricane Ike provided some special challenges for all government agencies including DSHS. DSHS worked diligently to get vaccines to the hardest hit areas in south Texas. Every emergency event allows opportunities to learn lessons with a focus on doing better the next time. Some valuable lessons were learned thanks to Hurricane Ike included the need to allow access to the registry by other states like Louisiana and that people going into the emergency areas need to be vaccinated before, in preparation for, and during the emergency.

ImmTrac, the statewide immunization registry, is expanding its role. It will now be the vaccine tracking system for first responders and their families during emergency situations. It will also be able to track adverse drug reactions. With parental consent, children born in the state of Texas will continue to be entered into the system as part of the birth registration process.

Flu season is upon us! The flu vaccine is being distributed as quickly as possible to sites throughout the state. There is enough vaccine to cover the need through February and March. DSHS is seeing an increase in the number of orders for the vaccine and in a variety of administration modalities. When vaccines were being administered in Galveston after Hurricane Ike, flu vaccines were included along with the adult Tetanus, Diphtheria and accellur Pertussis vaccine. (TDaP).

These are exciting times for TISWG and its collaborative members especially with the new legislative session under way. The Texas Nurses Association is proud to be part of TISWG and the work this group is doing to improve the health of all Texans. ★

References1. 4:3:1:3:3:1 series is a measurement of the 4 doses DTP

or DTaP, 3 doses Polio, 1 dose MMR, 3 doses Hib, 3 doses Hepatitis B, and 1 dose of Varicella vaccine used by the Centers for Disease Control and Prevention, National Immunization Program, National Immunization Survey, to determine the National Estimated Vaccination Coverage of children ages 19-35 months.

October TISWG Meeting


The 2008 Arthritis State Plan meeting was held in Austin on November 18th. Mandated by the 78th Texas legislature, the Texas Arthritis Program is designed to reduce the burden of arthritis on the citizens of Texas through secondary and tertiary prevention. The Program focuses on promoting self-management programs, health communication strategies, and prevalence monitoring.

Arthritis is a growing state and national public health issue. 4.1 million Texans reported having physician-diagnosed arthritis in 2007. Of those 4.1 million Texans, 1.7 million reported arthritis-attributable activity limitations due to arthritis and joint symptoms. Total Texas hospital charges in 2006 for arthritis were $2.2 billion. Medicaid claims for physicians, ER visits, and inpatient hospitalizations related to arthritis totaled $69 million. Arthritis has a significant impact on both the person experiencing painful symptoms and disability, and on the economic well being of the state.

The goal, of course, is prevention. However, if a patient is diagnosed with arthritis, referral to an evidence-based water, land, and/or self-help program a must.

The 2008 Arthritis State Plan Meeting provided an opportunity, under the auspices of the Texas Department of State Health Services, the Texas Arthritis Program, and the Texas Arthritis Advisory Committee, for a diverse set of partners representing the state, communities, healthcare organizations, healthcare professionals, professional associations, and academic sectors to meet and network and plan. The purpose of the meeting was to identify arthritis prevention activities that can be coordinated among agencies, outline existing resources, and provide input to the state-wide five year plan.

The meeting objectives included:

• Identifying current arthritis services, programs and activity in Texas.

• Identifying gaps in services, resources, and coordination.

• Agreeing on 3-5 arthritis-related objectives for 2008-2012.

• Agreeing on some realistic next steps to achieve the objectives.

The meeting attendees focused on five areas when addressing the objectives. The key areas were:

• Partnership/Capacity building

• Policy/environmental changes

• Health education/Communication/Outreach

• Clinical prevention/treatment

• Surveillance data/Outcome management

Out of the discussions and brainstorming that occurred came three objectives that the partners felt could be accomplished during the next year. These were:

• Develop an online communication tool for the partners in an effort to enhance future planning and maintain the momentum created by the meeting.

• Identify other agencies throughout the state with whom various partners could collaborate to enhance access to evidenced-based programs.

• Create a toolkit for primary healthcare providers (physicians/nurse practitioners/physician assistants) that provides diagnostic and treatment guidelines that will enhance early detection, early diagnosis, and appropriate treatment/management.

The 2008 Arthritis State Plan Meeting provided an excellent opportunity for stakeholders to come together, network, and identify where gaps in service exist and where activities are most needed in Texas for those suffering this and other associated chronic, disabling diseases. The Texas Nurses Association is proud to be a partner in the development of this five year plan and the work that is being done to lessen the burden of arthritis, thus improving public health in Texas. ★

Moving Toward a New Nursing

Curriculum Model in Texas

In the last Texas Legislative Session, the Texas Higher Education Coordinating Board (THECB) was directed to conduct a study in consultation with the Texas Board of Nursing on opportunities to improve the curricula of initial licensure nursing programs. In October 2008, the THECB released its report, A New Curriculum Model for Initial RN Licensure Programs. This report proposes the development of one or more common curriculum models for nursing programs which focus on safety and quality, and include strategies to maximize enrollment capacity and student success. The plan suggests building the curriculum model around the five core competencies for health education that were identified in the Institute of Medicine report, Crossing the Quality Chasm.

Using a regional approach, the curriculum model(s) would include standard pre-requisites, individual course descriptions, a recommended sequence of courses, and recommended methodologies. Implementation is proposed in phases and would require a significant commitment of resources although long-term gains are anticipated. The report can be accessed at www.thecb.state.tx.us. ★

TNA Joins 2008 State Arthritis Plan Meeting


Lance Armstrong Foundation Awards $150,000 Grant to Nurse Oncology

Education ProgramThe Lance Armstrong Foundation (LAF)

has awarded the Nurse Oncology Education Program (NOEP) a 2008 Community Program grant in the area of Education for Health Care Professionals. NOEP will provide Continuing Nursing Education (CNE) through numerous modalities to Texas nurses on survivorship issues including pain management, late effects, palliative care, emotional support, and practical issues for diverse populations such as childhood and adolescent/young adult survivors, ethnic and racial minorities, and rural populations.

NOEP also plans to increase nurses' knowledge and use of existing survivorship resources such as the Texas Comprehensive Cancer Control Coalition Goal V Survivorship Web portal. To further address current nursing school survivorship educational gaps, NOEP will increase enrollment for its Faculty Training Program, an intense, one-week educational opportunity at U.T. M.D. Anderson Cancer Center providing CNE to faculty for dissemination back to their respective nursing schools and curricula.

Visit www.noeptexas.org or e-mail [email protected] to learn more. NOEP is a project of the Texas Nurses Association/Texas Nurses Foundation and is funded by the Cancer Prevention and Research Institute of Texas. For information on the LAF, visit www.livestrong.org. ★

It’s been said that “nurses are the heartbeat of the health care system.” Without them, the system could not survive.

Sometimes, however, in their dedication to caring for others, nurses may forget to take care of themselves. This, too, can significantly burden the healthcare system, especially when nurses catch the flu. Statistics show that fewer than half (41.8 percent) of all health care workers were vaccinated against the flu during the 2005-2006 influenza season. In an era of nursing staff shortages and mandatory overtime, nurses may be heaping additional responsibilities on their co-workers when stricken with flu and unable to work.

But, there is a quick and easy fix for this problem: a flu vaccine. In fact, the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) recommend that all health care professionals who work directly with patients get an annual influenza vaccination. Because flu illness is caused by flu viruses that change constantly and the vaccine is updated every year, annual vaccination is needed for protection to remain current.

Fact vs. FictionSo why aren’t nurses and other health care

professionals protecting themselves? It may be because even within the medical

community, research indicates there’s a great deal of misinformation circulating about the flu vaccine. Despite the well-known benefits of the influenza vaccine, common misconceptions persist.

• Fiction: The influenza vaccine can cause the flu.

Fact: This is untrue. The flu shot contains inactivated viruses and the nasal spray contains weakened strains that are too insignificant to cause flu illness. Many studies confirm this. If a person gets the flu following a flu vaccine, it means that person had been exposed to the virus at least 3 to 5 days prior to showing symptoms. It can take up to two weeks from the time the vaccine is administered for immunity to kick in.

• Fiction: Nurses are immune to influenza, or have stronger immune systems, because they work around sick people every day.

Fact: Because influenza viruses are constantly changing, past exposure does not provide protection against new influenza virus strains.

• Fiction: The vaccine’s side effects are worse than getting the flu itself.

Fact: The most common side effects are redness and mild soreness at the injection site. These symptoms usually resolve themselves in one to two days. Persons who chose to get the nasal vaccine can avoid these injection–related problems, but can have nasal congestion or a runny nose for a day or two. The most serious side effect is an allergic reaction by those who have a severe allergy to eggs (the vaccine viruses are grown in eggs). For this reason, getting an influenza vaccination is not advised for

On the Front Line: Nurses Urged To Get Influenza Vaccination

Contributed by the Centers for Disease Control and Prevention

Continued on page 15


people with an egg allergy. But egg allergies are rare, and severe allergic reactions are even rarer.

• Fiction: The flu vaccine is not effective. Fact: When there is a good match between

circulating influenza virus strains and those in the vaccine, effectiveness rates have been as high as 70%-90% in healthy adults. Although the vaccine does not prevent everyone from getting ill, vaccination can make your illness milder. Plus the vaccine greatly reduces the chances of hospitalization and death.

The Scoop on FluAlthough influenza is mainly spread by

droplet transmission, the virus can also infect others by remaining infectious on contaminated objects — such as doorknobs, telephone receivers, food utensils and trays, beds and medical equipment — for hours. Also, people can spread the flu for a day or so before they even develop symptoms.

The period when an infected person is most likely to transmit the virus to others is during the first three days of illness. The chance of transmission wanes over five to seven days in otherwise healthy adults.

Influenza usually starts suddenly and may include the following symptoms:

• Fever (usually high)

• Headache

• Tiredness (can be extreme)

• Cough

• Sore throat

• Runny or stuffy nose

• Body aches

• Diarrhea and vomiting also can occur, but are more common in children.

General treatment for influenza includes bed rest, drinking plenty of fluids and taking over-the-counter medicines such as acetaminophen. Children suspected of having influenza should not be given aspirin, as this may increase the risk of a complication known as Reye Syndrome. In addition, there are prescription antiviral medicines that can help prevent influenza infection and, when used within the first 48 hours, can reduce the duration and severity of the illness.

The role that nurses and other health care workers play in helping prevent influenza-related illness and death — especially in at-risk elderly patients and young children — cannot be underestimated.

Patients of nurses and health care workers who are at the greatest risk for influenza-related complications include people 65 or older; individuals with chronic pulmonary or cardiovascular conditions; people with chronic illnesses such as diabetes mellitus, cardiovascular disease, kidney disease, cancer, AIDS/HIV and asthma; pregnant women; infants; children ages six months through 5 years and residents of nursing homes and other chronic care facilities. In addition to high risk groups, CDC recommends vaccination for all children aged 6 months through 18 years; people age 50 or older; and all healthcare workers to help curb the spread and possibly severe complications of influenza.

Continued from page 14 Two Easy OptionsThe influenza vaccination remains the best

way for nurses and others to protect themselves, their families and their patients during the annual influenza epidemic. All they need to do is choose the method of delivery.

Intramuscular influenza vaccination: Administered by shot, this is one of few immunizations that is recommended for all health care professionals, regardless of any special conditions (i.e., pregnancy, HIV infection, severe immunosuppression, renal failure, asplenia, diabetes and alcoholism/alcoholic cirrhosis.)

Live intranasal influenza vaccine: This live vaccine is approved for use in healthy persons 5 to 49 years of age, who are not pregnant, and do not provide care for severely immuno-compromised people when they are in a protective environment, such as a bone marrow transplant unit. Most healthcare workers who are younger than 50 years of age can receive the intranasal vaccine if they choose to.

Safe, Not SorryThe role that nurses play in helping others

is well known. Now, it’s time for nurses to consider how protecting themselves against the flu will also help them in their mission to protect others.

For more information about influenza and the influenza vaccine, visit www.cdc.gov/flu or call 800-CDC-INFO (800-232-4636). ★


Tools

CANCER CONTROL ToolkITT E XA S

Helping Communi t ies F ight Cancer

Developing Your Plan, Using Cancer Statistics, Media and Outreach, Working with Priority Populations, Finding Funding, Evaluating Your Efforts, and more.

does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Nurses are Again Tops in Honesty and

EthicsNurses are again perceived as professionals

with the highest of ethical standards and honesty. That fact, according to the annual USA Today/Gallup poll that rates honesty and ethics of workers in 21 different professions, results from 84% of Americans polled giving nurses an either “high” or “very high” ranking on honesty and ethical standards. With the 2008 poll, nurses receive top survey rankings from the public for the seventh consecutive year. Only in 2001 were nurses edged out for the very highest ranking when firefighters received the top honor.

Most of the professions surveyed in 2008 remained consistent in their rankings from a year ago. Bankers were the exception. They experienced a 12 percentage point decline in a positive rating and registered below 30%. This year’s record low of a 23% ranking for bankers is even worse than in 1988, when their image fell following the savings and loan crisis.

Following nurses in integrity rankings for 2008 were pharmacists, high school teachers, and medical doctors with close to two-thirds of Americans rating them “high” in ethics and honesty. Just over 50% of those polled rated police and clergy members as “high” or “very high” in their perceived honesty and ethics standards.

Shoring up the bottom of the image rankings, three professions — lobbyists, telemarketers, and car salesmen — are considered by a majority of Americans polled as having “low” or “very low” honesty and ethics.

Gallup first began asking about honesty or ethics in 1976. This year’s survey results were based on national telephone interviews of 1,010 adults that were conducted November 7-9. Source: Gallup.com. ★




A lot of Americans are cutting back on spending — feeling frugal, reluctant to part with hard-earned money. That’s why Texas Nurses Association just announced TNA Direct — a new, quite affordable $99-a-year membership option (or as little as $8.75 a month) with full TNA benefits that are state-level delivered, state-wide focused. TNA Direct is ideal for any RN who’s interested in advancing nursing practice in Texas while investing in their own personal career.

For just $99 a year (or as little as $8.75 a month), Texas RNs can be in-the-know about the hot-topic influences on nursing in Texas that will bring implications to daily practice. For as little as $8.75 a month, RNs can gain for themselves unique leadership experiences and the personal connections that professional membership allows. And there’s plenty of money-saving member discounts on TNA workshops,

NEW Participation Option for Texas Nurses

conferences, publications, resources, continuing education benefits, liability insurance and much more.

Grow as a professional, make a real difference in the nursing profession in Texas — all with one, quite affordable TNA Direct membership. Find out more today. Click on our Web site (texasnurses.org) or give us a call (800-862-2022). We’d be happy to personally provide the details of how professional membership in Texas Nurses Association is a career investment you should make today. Fill out the new membership application in this issue of TEXAS NURSING Voice or join online at www.texasnurses.org. ★

Visit our website at:

www.texasnurses.org

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