President’s Perspective · information. Nursing has moved into parish nursing, the neighborhood drug store and into the world of geriatrics. Collegiality between nursing and the

current resident or

Presort StandardUS Postage

PAIDPermit #14

Princeton, MN55371

Special Points of Interest:

• AmericanNursesAssociation\CaliforniaWelcomesNewANAPresidentPamelaCipriano

page 3

• CaliforniaCommunityCollegesMaySoonOfferBachelor’sDegrees

page 7

• ToxicDisinfectantsand YourHealth page 9

• SavetheDate!! ANA\CRNDay2015-ADay

attheCapitol page 11

• NursePractitionersasPrimaryHealthCareProviders

page 15

• ANA\CaliforniaCalendarofEvents

page 17

ANA\C is AN AffiliAte of the AmeriCAN Nurses’ AssoCiAtioN

Volume 19 • Issue 4October, November, December 2014

President’s PerspectiveMonica Weisbrich, RN

President ANA\C [email protected]

HelloColleagues,

Since my last message somuch has happened in theworld of nursing, healthcareand your Association. I willhighlight some areas I feel aresignificant and will have animpact on our profession. Asthe Affordable Care Act (ACA)isabouttoenteritssecondyear,the opportunities for nursingare surfacing resulting in doorsopening in arenas previouslyclosed to us. Acute care is nolonger the Mecca. Options forpatient care outside the brickandmortarenvironmentaregrowingbyleapsandbounds.Clinics are now being called ambulatory care centers.Healthcare systems are instituting “tele-a nursing” fortheirpatientpopulations togethelp24/7.Care ismovingtoward the home or specifically identified communities.Treatment algorithms for both nursing and medicine arebeingestablished.Theneedfordatahasneverbeenmoreacute.Dataareessentialwhenpreparingabusinessplan.So then there is the Internet—delivering informationto our patients at the speed of lightening. This requiresnurses and physicians to access current and comparativeinformation. Nursing has moved into parish nursing, theneighborhooddrug store and into theworldof geriatrics.Collegiality between nursing and the allied healthcommunity is greater than ever as both groups movetowardateamapproachtopatientcare.

Sowhere isANA\C in thisnewenvironmentandhowis your Association representing you? As I write to you

today, our State legislature is still in session therefore,there are no legislative outcomes to share. ANA\C is astakeholder in many arenas---the Community Paramedicproposedprogram,theAPRNCoalition,ScopeofPracticeissues, the Transition to Practice/Residency models,the California Action Coalition and the Quad Councilfocusing on the ADN to BSN in the community collegesystemtonameafew.AsanexampleANA\CattheAPRNCoalitionrepresentsthosenursesnotdesignatedasAPRNstoinsurethattheirscopeofpracticeisprotected.

InJune2014,theANAMembershipAssemblywasheldinWashington,DC.TheAssemblywasthesecondyearofathreeyearpilotprojectandpartofthereorganizationofANA. This year the Assembly included voting for ANABoardmembers.OurElissaBrown,RNwaselectedtotheNominatingCommitteeofANAandwillserveatwoyearterm and Dr. Liz Dietz was appointed to the ReferenceCommittee and also will serve a two year term. PhillipBautista,RNand Iwere your elected representatives andvotedforANAboardofficers.Wealsoparticipated inangroup exercisewhich had the end result of finalizing theresolutionsthatwillguideANAinthecomingyear.

As your President, one of my responsibilities is toassurethethreeAssociationcommitteesaremeetingtheirgoals and to provide feedback to themembership. ThesecommitteesareBallot,LegislativeandEndorsement.

Much work has been accomplished by the BallotCommittee in preparing for the upcoming election—oursecondtimetoelectronicallyvote!TheBallotCommitteewillbecommunicating individuallywith themembershipand through social media seeking potential candidates.Check out the ANA\C web site for a listing of openoffices including their duties and responsibilities. Aschangesadvancewithinourprofession,theneedforstrongleadership in our Association is more acute than ever.Please complete a consent to serve form and begin yourjourneyinvolunteerism.

Monica Weisbrich

www.anacalifornia.org

President’s Perspective continued on page 17

Do you wish that you could make a bigger impact on nursing with your expertise in a certain area?

The American Nurses Association/California is looking for your expertise to serve in a directional position.

Applytodayathttp://www.anacalifornia.org/formembershipandtorunforaboardpositionthatcanshowcaseyourexcellenceinnursingpractice,nursingeducation,legislativeadvocacyormembership

growthandretention.

It is to make your voice for nursing louder, stronger, and reverberate statewide.

Page 2 • ANA\C The Nursing Voice October, November, December 2014

Published by:Arthur L. Davis

Publishing Agency, Inc.

www.anacalifornia.org

Help us stay in touch: Do you have a new address or

e-mail address?

YoucanhelpAmericanNursesAssociation\California‘stay in touch’ by updating your contact information.Call ANA\C at 916-447-0225, e-mail us at [email protected]:

The‘Nursing Voice’c/oANA\C1121LStreet,Suite508Sacramento,CA95814

ANA\CMemberIdentificationNo.(ifapplicable)___________________________________________

Name:_____________________________________

NewAddress: _______________________________

___________________________________________

___________________________________________

OldAddress:________________________________

___________________________________________

___________________________________________

NewE-mailAddress:_________________________

*** This is not to update your license information with the Board of Registered Nursing.Go to www.rn.ca.gov

Article Submittal to ‘The Nursing Voice’ANA\California accepts and encourages

manuscripts and editorials be submitted forpublication in the association’s quarterly newsletter,The Nursing Voice. We will determine whichletters and articles are printed by the availabilityof publication space and appropriateness of thematerial. When there is space available, ANA\Cmembers will be given first consideration forpublication.Wewelcomesignedlettersof300wordsorless,typedanddoublespacedandarticlesof1,500words or less, typed and double spaced. ANA\Cwill accept larger narrative if space permits. Formore information please email [email protected].

ANA\California’s official publication, ‘TheNursing Voice’editorialguidelinesandduedatesforarticlesubmittalisasfollows.

1. Letters, Articles and Manuscripts should beword processed and double-spaced on one sideof8½x11inchwhitepaper.Manuscriptsshouldbe emailed to Editor at [email protected]. Letters, Articles and Manuscripts should

include a cover page with the author’sname, credentials, present position, addressand telephone number. In case of multipleauthors, list the names in order in whichtheyshouldappear.

b. The Nursing Voice reserves one-timepublication rights. Letters, Articles andManuscripts for reprintwill be accepted ifaccompaniedwithwrittenpermission.

c. The Nursing VoicereservestherighttoeditLetters, Articles and Manuscripts to meetstyleandspacelimitations.

d. Letters, Articles and Manuscripts may bereviewedbytheEditorialStaff.

e. Letters,ArticlesandManuscriptssubmittedbymembers’ ofANA\Cwill be given firstconsideration when there is an availabilityofspaceinthenewsletter.

f. Letters,ArticlesandManuscriptssubmittedtoANA\Cwillbepublishedasspaceallowsunlesscontentisofatimelynature.

g. Letters,ArticlesandManuscriptsprintedinTheNursing Voicedonotnecessarilyreflectthe views of ANA\C, its membership, theboardofdirectorsoritsstaff.

2. Photographs should be in jpeg format andemailed with the name of the Letter, Articlesor Manuscript referenced in the subject line.Email to TheNursingVoice@anacalifornia.orgPhotographsshouldbeofclearquality.Writethename(s) of thepersonsdisplayed in thephoto intheorderinwhichtheyappearinthebodyoftheemail.

3. E-mail all narrative to [email protected]

ANA\C Wants To See You….IN THE NEWS

Haveyouoroneofyourcolleaguesbeenrecognizedforanaccomplishment,electedtooffice,wonanaward,receivedagrantorscholarship,launchedanewventure?Tellusaboutit!Sendname,address,phonenumber,

andnewsto–

E-mail to: [email protected]

Mail to: ANA\California‘INTHENEWS’

1121LStreet,Suite508Sacramento,CA95814

Fax to:916.442.4394

AmericanNursesAssociation\CaliforniaisanAffiliateoftheAmericanNursesAssociation

The Nursing VoiceistheofficialpublicationoftheAmericanNurses’Association\California

ANA\CislocatedinTheSenatorOfficeBuilding1121L.Street,Suite508Sacramento,CA95814

Office916-447-0225–[email protected]

[email protected]

ANA\C 2013-2015 BOARD OF DIRECTORSOfficers

MonicaWeisbrich,BSN,RN-PresidentDianneMoore,PhD,MN,MPH,CNM,RN-VicePresident

DonnaDolinar,RN,BSN,MPA-TreasurerDirectors

Elizabeth“Liz”Dietz,EdD,RN,CS-HP-LegislativeElissaBrown,MSN,RN,PMHCNS-BC-PracticeMelanieKrupa,RN,MSN,CNOR-EducationPhillipBautista,BSN,RN,PHN-Membership

ADMINISTRATIONANA\CaliforniaExecutiveDirector&LegislativeAdvocate:

Hon.TriciaHunter,RN,MNANA\CaliforniaLobbyingFirm:GovernmentRelationsGroup

ANA\CaliforniaStaff:SamanthaMarcantonioANA\CaliforniaStaff:MarkétaHoušková

EDITORIAL COMMITTEELouiseF.Timmer,EdD,RN-Chairperson

DonnaDolinarRN,BSN,MPAElissaBrownMSN,RN,PMHCNS-BC

The official publication of the ANA\C shall be The Nursing Voice.

TheNursingVoiceispublishedquarterlystartinginJanuary;copy must be received by the first (1st) of November,February, May, and August to be included in the nextpublication. The publication is complimentary to ANA\Cmembers, schools of nursing and their nursing students,affiliates of the association and their memberships. If youwould like to submit a letter, article, or manuscript, forpublication please read ‘Article Submission forTheNursingVoice’inthisissueforsubmissiondetails.

Reprints and Submissions: ANA\C allows reprinting ofnewslettermaterial.PermissionrequestsshouldbedirectedtotheANA\CofficeinSacramento.(916)447-0225.

Advertising:AdvertisingRatesContact–ArthurL.DavisPublishing Agency, Inc. 517 Washington St., PO Box 216,CedarFalls,IA50613,800-626-4081,[email protected].

ANA\C and the Arthur L. Davis Publishing Agency, Inc. reserves 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 ANA\C 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. ANA\C 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.

Copyright©bytheAmericanNursesAssociation\California.

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October, November, December 2014 ANA\C The Nursing Voice • Page 3

ANA

American Nurses Association\California welcomesnew ANA President Pamela Cipriano, PhD, RN, NEA-BC,FAAN!CiprianowaselectedattheANAMembershipAssembly on June 14 to a two-year term.Here is a littlemoreaboutPresidentCiprianoandherhopesforthefutureofANAandtheprofession.

American Nurses Association\California Welcomes New ANA President Pamela Cipriano

ANA’s New President Takes the Helm, Lays out Priorities

Getting to Know ANA’s New PresidentPrior to becomingANApresident,Cipriano served as

senior director for health caremanagement consulting atGallowayAdvisorybyiVantage.ShealsohasheldfacultyandhealthsystemleadershippositionsattheUniversityofVirginia(UVA)since2000.

Cipriano is known nationally as a strong advocate forhealthcarequality,andservesonanumberofboardsandcommittees for high-profile organizations, including theNational Quality Forum and the Joint Commission. Shewasthe2010-11DistinguishedNurseScholar-in-ResidenceattheInstituteofMedicine.

A longtime ANA member, Cipriano has servedtwo terms on the ANA Board of Directors and wasthe recipient of the association’s 2008 DistinguishedMembershipAward.Sheactedas the inauguraleditor-in-chief of American Nurse Today, ANA’s official journal,from2006-14, and is currently amemberof theVirginiaNursesAssociation.

Vision for the Future of ANAIn a recent conversation with The American Nurse,

Cipriano shared her vision for ANA by outlining threeprioritiesforherpresidency.

First, shewill focusonANA’s“corestrengths,”whichinclude: political advocacy, efforts around safe staffingand healthy work environments, and fighting for nurses’rights to control their profession and practice to the fullextentoftheireducationandlicensure.

Second,Dr.Ciprianowillleadmembershipgrowthandretention. “I strongly believe in the old saying, ‘There’sstrengthinnumbers,’”shesaid.

Thethirdpriorityforherfirsttermincludespositioningnurses to exert greater influence in the transformation ofhealth care. “It’s very important for ANA to make surenurses are in prime positions and key decision-makinggroupssoourvoiceisthereateveryturn,”shesaid.

Finally, what does President Cipriano want membersaround thecountry tokeep inmind?Optimism.“Wearemaking a number of strides,” she said. “We’re going toneed all of our members...if we want to truly achieve anewdirectioninhealthcare.”

To read more about President Cipriano, please visit: www.theamericannurse.org/index.php/2014/06/30/meet-anas-new-president/

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Elissa Brown, new member of the ANA Nominations and Elections Committee

At the ANA Membership Assembly in June, I wasprivileged toattendasanextraobserverandasaCandidatefor theANANominations andElectionsCommittee. Itmaybe helpful to review the process for if and when you maydecide to run for office. Remember, running for office is aserious endeavor. Since nurses have leadership skills andpotential,pleasedoconsiderbeingacandidatesomeday.

In thinking about being a candidate, first and foremostis how to decide to run. You need to believe that you are:qualified for the position, able to bring valuable knowledge,skills and experience, able to plan your schedule to do thework, and committed to doing your best in the position. Ithelps to plan to spend time, and somemoney, on this, andto have support from colleagues. Timing is important…andhavingrecentlyretired,IbelievedIhadmoretimeandcoulddoacommendablejobonthiscommittee.(Ofcourse,Ihavebecome—as friends warnedme, “a retired busier than everperson”—busypeoplestaybusy!)

ANA

Thestepstobecomingacandidate:submityournamefortheposition.InthisANAElection,eachofthecandidateshadtocompleteformstobesubmittedandreviewedbyANA.Inashortperiodof timewewerenotifiedifwewereapprovedto be on the ballot. Then we received more information,including an Elections Manual and directions on how ourcampaigns can be run, including identifying a campaignmanager. Iwas fortunate tohaveDr.LizDietz, ourANA\CDirector for Legislation, as my lovely campaign manager.Throughout the process, there was much support fromANA, including timely responses to anyquestions.Of greathelp was being able to send our campaign materials to theMembershipAssemblyRepresentatives throughANA,eitherviaemailoronecouldchoosetobuymailinglabels.Isentmymaterialsonline.

Prior to theMembershipAssembly, all of the candidatesfor office were invited to the ANA Board open session onWednesday-which I did attend. Itwas a nice opportunity tohearsomeof theissues,meet theBoardandstaff,andothercandidates.

TheMembershipAssemblyElections:wewereallowedtosetupourdisplaysonThursdayafternoon.IbroughtabannerI had made, and gave away flyers with my information,wrapped“ThankYou”buttermints,andgoldtonepenswith“VoteforElissaBrownforANANominationsandElectionsCommittee” on each. I also bought decorations, pictures,etc.,andhadaplanformydisplaytable(eachcandidatewasassignedatableinadesignatedcampaignroom).Abigthankyou to ANA\C members, Liz Dietz, Anne Hughes, MonicaWeisbrich,andMelanieKrupawhoreallyhelpedmakesurethedisplaywasartisticandgreat,andhelpedincampaigningfor me! Thank you, too, for support from our other ANAmembers present: Tricia Hunter and Phillip Bautista. Ireceivedcomplimentsfromothersaboutthedisplayandmanymentioned the fact thatoftenpeople running fornominatingcommitteesdonotdosuchanicedisplay,i.e.,usuallyjusttheofficers do that. They commented that it showed I believedthiswasanimportantcommittee.

Early Saturday morning, the Membership AssemblyRepresentatives,andANABoardvoted.Campaignmanagershad to go for an early (5:15 am—bless you Liz!) briefingand then some sat in as observers to the voting process.Sincesomeoftheofficeshadanumberofcandidatesontheballot,andthewinnerneededtohaveamajorityofthevotes,2 runoffs elections were required; therefore more votingcontinuedthroughthemorning.

Followingthevoting,thecandidatesweredirectedtogotothevotingarea toreceiveanenvelopewitha letter--sayingeithercongratulationsyouwon-ornot.Oneneverknowstillthefinalcount.

Iwasmorethanpleasedtohavebeenelected!Iwouldbehappy to talkwithanyonewho isconsidering

running for an association office, state or national, andwould sharemymaterials.Pleasecontactme throughANA\California.

Again, thankyou tomy friends and colleagues for all ofthesupport!Ishalldoyouproud.

“What you do, what you say, what you are, may help others in ways you never know. Your influence, like your shadow, extends where you may never be.” Anonymous

On Being a Candidate for an Elected ANA Position

Nurses Go to the Hill (Capitol Hill) Anne Hughes, RN, PhD, FAAN

ANA\C Membership Assembly Observer

On June 12th, the day before ANA’s MembershipAssembly convened in the nation’s capital, nurses fromaroundthecountryinpersonandonline,connectedwiththeir elected officials, representatives and senators, forthe2014ANALobbyDay.ANA\Cmembersparticipatedin theseadvocacy/lobbyingefforts.Thedaybeganwithabreakfasttrainingsessionthatcovered‘lobbying101.’

Successful advocacy/lobbying skills include: knowingthe policy interests and committee appointments of yourrepresentatives, being prepared to articulate clearly thelegislative priorities you are speaking to, being punctualand polite (not dismissing or ignoring staff memberswho you will most likely be meeting with rather thanyour elected official), if possible linking how whatyou’re asking for is aligned with the interests of otherconstituentsyourelectedofficialrepresents,addressingtheargumentsofotherswhowould takeanoppositepositionthan the stance you are advocating for, and if requested,providing additional information or resources to assistyourmember(electedofficial)tounderstandyourposition,your‘ask.’

ANAidentified four legislativeprioritiesaboutwhichthe nurses going to the hill educated their members:(1) Durable Medical Equipment, H.R. 3833 (allowingadvanced practice registered nurses to order DMEeliminating the physician co-signature); (2)HomeHealthCare Planning and Improvement Act, H.R. 2504/S.1332(allowingAPRNstoorderandsignplanofcareforhomehealth care services which would facilitate access tothese vital services); (3) Safe Staffing, H.R. 1821/S2353( requiring Medicare-participating hospitals to establishunit specific staffing plans designed by a committeethat includes55%directcarenurses)and (4)SafePatientHandling&Mobility,H.R.2480(abillthatwouldamongother provisions would require OSHA to develop andto monitor safe patient handling and mobility standardsto prevent and to reduce the frequency of occupationalmusculoskeletal injuries to nursing assistants andregisterednurses).

TheCaliforniadelegationmetwiththelegislativestaffof our two senators, Senator Diane Feinstein (FellowJames Hamos) and Senator Barbara Boxer (HealthPolicy Advisor Emily Austin Katz), and two House ofRepresentatives members, Congresswoman Jackie Speier[CA-14] (Legislative Assistant Molly Fishman) andCongressmanDarrellIssa[CA-49](DeputyChiefofStaffVeronicaWong).TheCaliforniadelegationwasdelightedtohaveinourmidst,the2014-15Presidentofthe60,000-memberstrongNationalStudentNursesAssociation,KellyHunt, who lives with her family near Camp Pendleton.Our professionwill be in good handswith this nurse-in-trainingandherpeers.

At the end of the day, beyond having tired feet (andappreciatingthevalueofgoodwalkingshoes)wewereleftwith an appreciation for the complexityof our legislativeprocess and the commitment of many elected membersand their staffs to do the right thing. Finally we wereremindedof thepowersofnursing’svoice toadvance thehealthcareofourcommunity.

Drs. Battey and Plodek are conducting a NEIRB 14-182 study with 10 CNE on Spiritual Care in Nursing.

Thisstudyhastwofocuses.OneistovalidatetheSpiritual-Communication-Satisfaction-Importance(SCSI)Questionnaire(Battey,2010)andtodetermineifanonlineeducationalprogramcanincreasenurses’perceptionofprovidingspiritualcaretopatients.

Nurseswhomeetthefollowingcriteria:atleast1yearofdirectpatientcare;Englishasafirstorsecondlanguage.Eachparticipantwillneedto1.)purchasetheaccompanyingguidebookletfortheeducationalmodulesfor$43,2.)followthelinktoMonkeySurvey,3.)readandsignInformedConsent,4.)completetheSCSIpretestsurveyonthesamepage,5.)thenfollowthelinkattheendofthesurveytotheeducationalmodules,6.)eachparticipantcanworkathisorherownpacebutmustcompletethe9modulesincludingthemodule#9test.EachmoduletakesaboutOne(1)hourtooneandhalf(11/2)hourstocomplete.,7.)thenfollowthelink,attheendbacktotheSCSIposttestfor 10 CNEcreditsfromtheAmerican Holistic Nursing AssociationIfyouareinterestedinlearningmoreaboutthisexcitingopportunity,[email protected]“SpiritualityInformationrequestedinthesubjectline”orcalldirectlytoASKat1-800-292-7211tostartyourjourneyexploringSpiritualcareorcontactNursingResearchConsultant,[email protected].

March 9, 10, 11, 2015

33rd Annual High SierraCritical Care Conference

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For more information call:775.829.5864


ANA

Phillip Bautista, Membership Director

This past June, in Washington DC, ANA held the2014 Membership Assembly. Nurse leaders gatheredfrom all over North America to guide the directionof the association as it leads healthcare through themany changes and challenges we face in our future.To be elected as one of the Membership AssemblyRepresentatives was quite an honor, and encouragingto see the support for nursing leaders that have recentlyentered the profession. One of the most prominentmemories that stuck out to me during the assembly wastheNightingale Tribute. To see the names of nurses thatarehonoredafterpassingawaywasaveryupliftingtributeto see that we remember and honor, as an association,thosewhohavemadethechoicetoserveourcommunitiesas RNs. I was very impressed by the entire slate ofleaders that ran forpositionson theANAboard,andourassociation is extremely fortunate to be represented andfull of individuals with such extensive and impressivequalifications.

The Membership Assembly was a very excitingexperience, and I would encourage any RN who isinterested in advancing the profession of nursing, toconsider attending this event. To see the discussions anddialogue firsthand was to experience the plethora ofknowledge,passion,anddedicationofhundredsofnursingleaders to advance our profession and association to benewheights.Theneedfornursingleaderstostepforwardand share their knowledge, passion, and enthusiasm wasnever clearer. Outgoing ANA President, Karen Daley,delivered an inspiring message for attendees, and a pastquotebyherwasmostappropriate.“There has never been a more critical time for nursing to come together – we are standing at the frontier of great change. It’s time for all of

First Time Perspective at the ANA Membership Assemblyus to roll up our sleeves and have a hand in shaping the direction and future of health care.”

We all have the ability to lend a hand in shaping thedirectionandfutureofhealthcareasRNs.Wepossesstheknowledge and experience to share real solutions to thenumerous problems and questions that health care facestoday. Californiawaswell represented, andwe even hadonemember,ElissaBrown,electedtoanationalposition.When considering that California has over 400,000 ofthe approximately 3million actively licensedRNs in theUnitedStates, itwasinterestingtoseehowsmallerstateswere represented in larger numbers than California.One of our neighbors to the north, the Oregon NursesAssociation, had a larger representation than Californiadue to a higher membership in ANA. While Californiais definitely large enough to include the cultures andpopulationsofseveralstates,thereisnogoodreasonwhywe have lowermembership numbers than smaller states.This directly affected me, both as a member and theelectedMembershipDirector.

The takeaway that I received from this assemblywas the tremendous value and benefit potential thatour association holds, and how imperative it is for usto realize and live up to that potential. With numbersbehind other states, it has reaffirmed my commitmentto continue seeking the membership increases that ourstatehasexperienced.Wehavedoneagreatjobsofarbyincreasingmembership in the state, and I give the creditfor these increases to individuals like you. By reachingouttothenursesonyourunit,inyourspecialtyandotherassociations, and even personal nursing friends, youhave helped to grow the numbers of ANA California.We havemade great accomplishments, butmorework isneeded. California has such an incredible opportunity tohelp lead the nation into the future of healthcare, and I

ask that you continue to promote the association and theprofession.Thankyouforallofyourtimeandefforts.Bybeingelected to themembershipassembly, itwasagreatopportunity to thank you as members by representingCalifornia, but to also invite all of you as potentialattendees at the next Membership Assembly. Thank youagain for your support of ANA California. If you haveany other questions about the Membership Assemblyexperience from the perspective of a first time attendee,or questions about ANA California Membership, pleasefeel free to email me at [email protected],ANA\CMembershipDirector

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Tribute Poster

Pinning CeremonyLiz Dietz

Elissa Brown

ANA Membership Assembly

ANA Board Oath


Josh Dulaney, The Daily Breeze

Up to 15 community colleges could start offering abachelor’s degree next year under a bill working its waythroughthestateAssembly.

Senate Bill 850, introduced by state Sen. Marty Block,D-San Diego, would authorize California CommunityColleges,inconsultationwiththeCaliforniaStateUniversityand University of California systems, to launch thebaccalaureatedegreepilotprogramJan.1.

“What we’re seeing nationwide is there is a huge skillsgap, and soweknow the community collegeshavenot justtheability to fill thatgapbut areuniquelyplaced todo it,”saidKevinPowers,alegislativeconsultantforBlock.

In an experimental departure from current law thatrestrictscommunitycollegestoofferingtwo-yearassociate’sdegrees only, SB 850, which passed the state Senate lastmonthbya34-0voteandisintheAssemblyCommitteeonHigherEducation,wouldallow15campusesamongthe112community colleges in the state to offer one baccalaureatedegreeeachunderthepilotprogram,beginningnolaterthanthe2017-18academicyear.

California would join more than 20 other states inallowingcommunitycollegestoofferbachelor’sdegrees.

The state community college Board of Governors andChancellor, inworkingwithCSUand theUC,wouldselectwhich districts and campuses are allowed to participate intheprogram.Bachelor’sdegreesofferedatthe15communitycollegesmustnotbeavailableat the state’spublic four-yearschools, and the college districtsmust document the unmetworkforceneedsthatthedegreewouldhelpfill.

UnderSB850, participating community college districtswouldberequiredtoreporttotheChancellor’sOfficeonthepercentageofstudentscompleting thebaccalaureatedegree,the fiscal self-sustainabilityof theprogramand thenumberof studentswho received jobs in the field of study of theirdegree.

TheUC systemhas not yet taken a position onSB850.AspokespersonsaidThursday it isstillbeinganalyzedandthe system has historically viewed the state’s Master PlanforHigherEducationas “anefficientwayofmanagingandallocating limited resources to equally important highereducation functions” that has served California well. CSUfavorsthebill.

“The California State University supports SB 850 andappreciates the collaboration by Senator Block and hisstaff on trying to meet the state’s workforce needs,” CSUspokesman Mike Uhlenkamp said in an email. “We look

California Community Colleges May Soon Offer Bachelor’s Degrees

forward to working with our colleagues at the CaliforniaCommunity Colleges on finding innovative ways to meetneworunmetdemands infieldsofstudyandareas thatarenotcurrentlyservedbyourcampuses.”

Last week, the Chancellor’s Office for CaliforniaCommunityCollegeswrotealetterofsupportforthebilltoAssemblyman DasWilliams, D-Santa Barbara, who chairsthe higher education committee, saying SB 850 “does notseek to change the mission of the community colleges intheMasterPlan forHigherEducation. Itonly seeks tohelpthe state of California address unmet workforce needs infieldswhereentryrequirementshaveprogressedbeyondtheassociatedegreelevel.”

FEES CAPPEDSB850as currentlywritten requires that students in the

pilotprogramnotbechargedfeeshigherthanthemandatorysystemwidefeeschargedforbaccalaureatedegreeprogramsatCSU.

A funding model to support the program must bedevelopedbytheCaliforniacommunitycollegesystem,andPowerssaidfundingcouldcomefromsourcessuchasgrantstofundinnovationinstatehighereducation,orstatefundingforcareertechnicaleducation.

The bill has received support from more than a dozencommunitycollegedistrictsinthestate.

“For other districts, especially if they are miles andmiles fromaCSUandaUC, for the remotecolleges, it’s avery good bill for them,” said Linda L. Lacy, president-superintendentofCerritosCollegeinNorwalk.“It’sworkinginotherstatesanditcanworkinCalifornia.”

Cerritos College, which partners with Michigan-basedNorthwoodUniversitytoofferbachelor’sdegreesinbusinessadministration and in automotive marketing management,with students completing three years at the communitycollegecostandthefourthatNorthwood’scost,hadwantedtoincludeitsnursingprogramunderSB850,butcan’tundertheprovisionthatbarscommunitycollegesfromofferingthesamedegreesasCSUorUC,Lacysaid.

KEEPING STUDENTS IN CALIFORNIALacy saidSB850 is needed, in part, to keepuniversity-

boundstudentsinCalifornia.CSU Chancellor Timothy P. White said recently that

because of the state’s budget constraints, the system hasexperienceda12percentincreaseinapplicationsandturnedawaymore than25,000 fully eligible students over thepasttwoyears.

“We’vehadarealproblemwhenwe’vehadtransfer-readyCSUandUCstudents,andwe’veforcedthemouttoout-of-stateuniversitiesandinstitutions,”Lacysaid.

In the San Diego Community College District, where top officials support SB 850, administrators have considered health information technology, automotive tech management and advanced manufacturing, among others, as potential four-year degree offerings, if the bill is signed into law.

“The public universities either do not offer bachelor’s degrees in these fields, or are impacted to such an extent they cannot comply or provide access to enormous student demands,” said district Chancellor Constance Carroll.

Othercommunitycollegeofficialsaretakingawait-and-seeapproachtothepilotprogram.

“While Long Beach City College will not participate, Iwillbeinterestedintheresultsoftheprogramshoulditpassand be signed into law,” said LBCC President Eloy OrtizOakley.

EARLIER ATTEMPTSBlock, a former president of the SanDiego Community

College District Board of Trustees, who is chair of theSenatebudget subcommitteeoneducation,has twicebeforeintroducedsimilarlegislation.

Asanassemblyman,he introducedAB2400 in2010, toauthorize the San Diego, Grossmont-Cuyamaca and SanMateoCountycommunitycollegedistrictstoestablishfour-yeardegreepilotprograms,butthebillwasheldinactiveinthe Assembly’s Committee on Higher Education. In 2011,AB 661would have allowedGrossmont-Cuyamaca and theSanMateo districts to offer one baccalaureate pilot degreepercampus,but thebillwasheld in the inactive fileon theAssemblyFloor.

Powers said it was an idea introduced in austere times,but with the proliferation of for-profit schools and manycommunity colleges already granting certificates andtwo-year degrees in fields not offered by public four-yearcampuses,extendingsomeofthosedegreestothebachelor’slevelisastepintherightdirection.

“Ithinkthelandscapeissodifferent,”Powerssaid.

ContactJoshDulaneyat562-714-2150.http://www.dailybreeze.com/social-affairs/20140621/

california-community-colleges-may-soon-offer-bachelors-degrees

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Assembly Member Nancy Skinner

When I learned that nurseswho are exposed to medicaldisinfectantshavetwiceasmanymiscarriagesasnurseswhodon’twork around these chemicals,I started looking for answers.As I investigated the dangersof toxic disinfectants andhealthcare-associated infections(HAI’s), I began to appreciatethecomplexityof thechallengesfacingthosewhoareresponsibleforprotectingpublichealth.

As surgical and central-line bloodstream infectionsdrop, two of the most commonHAI’s,ClostridiumDifficile (C. diff) and Methicillin-resistantStaphylococcus aureus(MRSA),have stubbornly resistedthe best countermeasuresmedical science can throw atthem. C. diff and MRSA infections are becoming moresevere and more resistant to antibiotic treatment. Onceconfined to healthcare facilities, these infections nowthreaten otherwise healthy people in schools, day carecenters, dormitories, locker rooms, barracks, prisons andretirementhomes.

Recent data from Europe and the U.S. show that 6.9percent of nurses, and 4.6 percent of healthcareworkers,carryMRSA.Theymayinfectpatients,friendsandfamilymembers while sometimes not getting sick themselves.

Assembly Member Nancy Skinner (D) represents the 15th Assembly district, which includes the

East Bay cities along the I-80 corridor from Hercules to

Oakland

LegislativeCollaboration Will Help Win the

Fight Against Healthcare-Associated InfectionsThatmeans 60,000 healthcareworkers, including 20,000nurses,couldbecarryingMRSAinCalifornia.

One of three superbugs classified by the Centers forDisease Control as an “urgent” threat, C. diff will kill14,000 Americans this year. Infections increase hospitalstays by 2.8 to 5.5 dayswith inpatient costs of $3,006 –$15,397perinfection.C. diffpatientsaretwiceaslikelytobedischargedtoalong-termcarefacility.

Medical disinfectants are critically important inthe fight against infections, but the disinfectants nowcommonly used are toxic and threaten the health ofworkersand theenvironment. Incollaborationwithotherenvironmental and occupational experts, the LowellCenter for Sustainable Production at the University ofMassachusetts published a report in 2009 reviewing thedangersofmedicaldisinfectants.Thereportcitesmedicalresearch around the world linking toxic disinfectantsto “serious respiratory ailments, eye and skin irritation,central nervous system disorders, reproductive disorders,blooddisorders,andevencancer.”

Environmental harm related to toxic disinfectantsincludesairandwaterpollution,bioaccumulationinplantsand animals, endocrine disruption in wildlife and ozonedepletionareamongthehazardsassociatedwithchemicalsfoundintoxicdisinfectants.

Last year, I introduced AB 1202 (Chapter 678,Statutes of 2013), which directs the Occupational Safetyand Health Standards Board to adopt rules for the safehandling of antineoplastic drugs. Legislation like thismaybenecessary toprotectnursesandothersfromtoxicdisinfectants.

I recently invited stakeholders who are the mostdirectly affected by HAI’s to share information andpropose solutions to stop infections safely. As science

has advanced, it should not be necessary to endangerthe health ofworkers and the environment to protect thepublic from dangerous infections. Public policy shouldrecognizethatreality.

Sources“Occupational Exposure Among Nurses and Risk of

Spontaneous Abortion,” American Journal of Obstetricsand Gynecology, April 2012. http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS0002937811024707.main-abr.pdf?jid=ymob

“Review of MRSA Carriage Among Healthcare Workers inNon-outbreak Settings in Europe and the U.S.,” InfectionControl Today, July 2014. http://www.infectioncontroltoday.com/news/2014/07/review-of-mrsa-ca r r iage-among-healthcare-workers-in-nonoutbreak-settings-in-europe-and-us.aspx

“Cleaning in Healthcare Facilities,” Health Care WithoutHarm, Global Health & Safety Initiative, Lowell Centerfor Sustainable Production (UMass), UIC School of PublicHealth, April 2009. http://www.sustainableproduction.org/downloads/CleaninginHealthcareFacilities.pdf

“Healthcare-associated InfectionsProgressReport,”Centers forDiseaseControlandPrevention,March2014.http://www.cdc.gov/hai/progress-report/index.html

“MultistatePointPrevalenceSurveyofHealthCare-AssociatedInfections,”NewEnglandJournalofMedicine,March2014.http://www.nejm.org/doi/full/10.1056/NEJMoa1306801

“AntibioticResistanceThreatsintheUnitedStates,”CentersforDiseaseControlandPrevention,April2013.http://www.cdc.gov/drugresistance/threat-report-2013/

“Compendium of Strategies to Prevent Healthcare-AssociatedInfections in Acute Care Hospitals,” Infection Control andHospital Epidemiology, August 2014. http://www.jstor.org/stable/10.1086/677216

California State University Northern California Consortium Doctor of Nursing Practice

Why pursue the Doctor of Nursing Practice at California State University?• DNP is a practice-focused doctoral degree

• In addition to meeting requirements of the Essentials of Doctor Nursing Practice as outlined by AACN, students will complete additional coursework in teaching strategies, curriculum development, and may elect to complete a nursing education

practicum to prepare for faculty roles.

What are the unique components of our Doctor of Nursing Practice program?• Joint program between Fresno State and San Jose State Universities

• Completely online with 1-4 days of intensive class sessions per semester• 21 months, 5 semesters including one summer session

What are the D.N.P. Admission Requirements?• Meet requirements for admission to California State University, Fresno.

• Have earned an acceptable Master’s degree with a GPA of ≥ 3.0.• Maintain an active California Registered Nurse License.

• Meet requirements for certification in appropriate nursing specialty area.• Has preparation and experience as an APN or nurse administrator/executive/educator.

Applications are accepted October 1, 2014 - April 1, 2015. The application is available on the CSU Northern California Consortium DNP website.

http://www.fresnostate.edu/chhs/nursing/degrees-programs/dnp.html

LIVE.LEARN.LEAD.


Legislative

Gayle Sarlatte, ANA\C Member

On July 15, 3014, Assemblymember Nancy Skinner, representing the 15th District, held aconversationwith stakeholders at theCapitol in Sacramento. TriciaHunter andGayle SarlatterepresentedANA\Catthismeeting.

The purpose of this conversation was to gather further information from stakeholdersregarding toxicdisinfectantsused inavarietyof settings, fromhealthcare to first responders,schools,andcorrectionalfacilities.AssemblywomanSkinnerauthoredlegislationlastyear(AB2674{Skinner})thatwouldhaverequiredtheOccupationalSafetyandHealthStandardsBoardtodevelopregulationstoprotectworkersandpatientsfromexposuretotoxicdisinfectants.ThisbillwouldalsohaverequiredtheBoardtoconsidercurrentscientificevidenceandrecommendationsof the National Institute for Occupational Safety and Health (NIOSH) of the US. Centerfor Disease Control. This legislation did not proceed this year pending further informationgathering.Thismeetingwasastepinthatprocesstohelpdeterminewhat’scurrentlybeingdone,whatcanbedone,andarenewregulationsorlegislationneeded.

Some, but not all, groups represented at this meeting included: California MedicalAssociation (CMA), California Academy of Family Physicians (CAFP), American Academyof Pediatrics, California (AAPCA), California Professional Firefighters (CPF), AirResourcesBoard (CARB),WorkSafe, Johnson& Johnson (J&J),CloroxCompany, SBioMed,California Department of Toxic Substance Controls (DTSC), Occupational Safety and HealthAdministration California (Cal OSHA), California Department of Public Health (CDPH),CaliforniaHospitalAssociation (CHA),Association for Professionals in InfectionControl andEpidemiology(APIC)andAmericanNursesAssociation\California(ANA\C).

Toxic Disinfectants and Your HealthA Roundtable Discussion, State Capitol Sacramento CA

Stopping HAI’s: A Top Priority for ANA\California

Tricia Hunter, RN

Worries about getting sick are a big reason nurses avoid certain assignments or leavenursingaltogether.ANA\CaliforniaisgratefultoAssemblyMemberSkinnerforinvitingustojoinwithotherhealthcareproviders,workers, first responders,environmentalistsandpublichealthmanagerstoreduceC.diff,MRSAandotherhealthcare-associatedinfections(HAI).

ANAmemberscanlearnmoreaboutthethreatofHAI’sandcontributeyourperspectives,experiences and ideas to protect thosewho exposed to infections and toxic disinfectants intheworkplace.Weareespeciallyinterestedinmeasuresthathavebeeneffectiveinprotectingnurses and other workers from HAI’s and the toxic effects of disinfectants. Data thatdocumentstheimpactofHAI’sonhealthcareworkersandtheenvironmentwouldbehelpful.

The information and ideas collected from nurses and other stakeholders will be postedat StopInfectionsSafely.org.The site contains government and academic data onHAI’s, theeffectsoftoxicdisinfectantsandmeasuresyoucantaketoprotectyourself.Subscriberswillreceiveupdatesonnews,studies, legislativeandregulatoryproposalsandother informationthatyourcommunitycanusetostopinfections.

ContactANA\[email protected].

Get the protection you need—without paying more than you need. To take advantage of special rates for ANA members, visit proliability.com/65691 for an instant quote and to fill out an application. Or call 800-503-9230.

For about the cost of a year’s worth of scrubs, you can get a year’s worth of protection from malpractice lawsuits—with malpractice coverage offered by the American Nurses Association (ANA).

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Innoparticularorderofimportance,thesebulletpointsweresomethoughtsbroughtforwardforconsideration:

• Focusontheattempttousethemosteffectiveproduct/processthatisleasttoxictothoseexposedtoit.

• GoaltoreducethenumberofHAIssafely.• Hopetogatherinformationononerepositorywebsiteaccessibletoall.• CADepartmentofHealthwebsitemayhaveusefulinformationposted.• The 2012 study published in the American Journal of Obstetrics & Gynecology

that was referenced in the original legislation found that pregnant nurses exposed totoxic disinfectants are twice as likely to have miscarriages as nurses not similarlyexposed.However, thisstudycoverednurses fromtheperiodof1993-2002,prior to theimplementationofadditionalsafehandlingrequirementsofthingslikechemotherapeuticagents.Thedatamaynolongerbeanissue.

• Weshouldlookatenvironmentalcleaningandtheexposureofworkers/patientstothoseproducts.

• OSHAhasahazardcommunicationprogram;lookatthisinformation.• C.Difficilehasbecomenotonlyahealthcarefacilityproblem,butacommunitybased

problem.• ShouldalsoconsidertheissueofGreenChemistryProgram;cautionaboutthelengthof

timeforthisprocess.• U.ofMassachusetts,Lowellhasdoneextensiveworkoncleaningproductsandtheuseof

disinfectantsinhospitals.• NIOSHhasconductedOccupationalHealthResearch• ConsidersystemsalreadyinplacesuchastheSpauldingClassificationsystem.• Regulations to reduceexposure limitsofglutaraldehydewere implemented8yearsago;

anti-neoplastic drug regulations came into effect last year; looking at other things likeaerosoltransmissiblediseases.

• The Academy of Physicians has a HAI-Advisory Committee that may have usefulinformation.

• Manyoftheprofessionalorganizationshavepublishedstandardsthatmaybehelpful.

It is hoped that the timeline for this process will allow the next couple of months foradditionalinformationgathering.Informationwillthenbecataloguedandanalyzed.Oncethatiscomplete,itishopedthatideas,policyrecommendations,etc.willemergebytheendofthisyear.


Legislative

What You Should Know about Healthcare-Associated Infections

How common are healthcare-associated infections (HAI)?

One in 25 hospital patients – 722,000 Americans --contracted a healthcare-associated infection (HAI) in2011,according to theNewEnglandJournalofMedicineand theU.S. Centers forDiseaseControl and Prevention(CDC). This does not include healthy people whocontracted dangerous infections in their communities.The annual societal cost ofHAI’swas estimated at $147billionina2013studypublishedintheJournalofMedicalEconomics.

Are HAI’s fatal?75,000AmericansdiedfromHAI’sin2011.

Has there been any progress in fighting HAI’s?Some infections have declined in recent years, but

two of the most common, C. diff andMRSA, persist atdangerous levels. These infections have become moresevere,moreresistanttoantibioticsandmoreprevalentingeneralcommunitysettings.Anyplacepeopleassemble–schools,daycarecenters,retirementhomes,lockerrooms,militarybarracks andprisons– canbebreedinggroundsfordangerousinfectionssuchasC. diffandMRSA.

BarChart:MixedResultsintheFightAgainstHAI’s• Surgicalprocedures–Down20%• Central-linebloodstreaminfections–Down44%• MRSA–Down4%• C. diff–Down2%

BarChart:GermsCausingHAI’sC. diff–12percentMRSA–11percentKlebsiella–10percentE. coli–9percentEnterococcus–9percentPseudomonas–7percent

Sources1. “Healthcare-associated Infections ProgressReport,”Centers

forDiseaseControlandPrevention,March2014. http://www.cdc.gov/hai/progress-report/index.html2. “Multistate Point Prevalence Survey of Health Care-

Associated Infections,” New England Journal of Medicine,March 2014. http://www.nejm.org/doi/full/10.1056/NEJMoa1306801

What You Should Know…• Healthcare-Associated Infections • C. diff • MRSA • Toxic Disinfectants • Protecting Yourself

3. “CompendiumofStrategiestoPreventHealthcare-AssociatedInfections in Acute Care Hospitals,” Infection Control and Hospital Epidemiology, August 2014. http://www.jstor.org/stable/10.1086/677216

4. “Economic Burden of Healthcare-Associated Infections inAcute Care Hospitals: A Societal Perspective,” Journal of Medical Economics,December2013.http://informahealthcare.com/doi/abs/10.3111/13696998.2013.842922

What You Should Know About Clostridium Difficile (C. diff)

What is C. diff?C. diff is fecal bacteria that can live on surfaces such

as door handles, toilets, and TV remotes for months.Transferred by touch,C. diff causes inflammation of thecolon (colitis) and severediarrhea.C. diff isoneof threesuperbugsclassifiedbytheCentersforDiseaseControlasan“urgent”threatasinfectionsarebecomingmoresevereandmoreresistanttoantibiotics.

Is C. diff fatal? 14,000 Americans will die from C. diff this year.

Infections increase hospital stays by 2.8 to 5.5 dayswithinpatient costs of $3,006 – $15,397 per infection.C. diff patientsaretwiceaslikelytobedischargedtoalong-termcarefacility.

Who’s in danger? Once limited to healthcare facilities, half of C. diff

infections are now contracted in the community. Seniorsare particularly vulnerable as well as those with weakimmunesystems,patientsrecoveringfromgastrointestinalsurgeryandpeoplewhohavebeentakingantibiotics.

Has there been progress fighting C. diff? Billionsofdollarshavebeenspent tofightC. diff,but

therehasbeennegligibleprogress.WithanationalgoaltoreduceC. diffby30percentbeforetheendof2013,therewasonlyatwopercentdrop.

Sources1. “Strategies to Prevent Clostridium difficile Infections in

Acute Care Hospitals: 2014 Update,” Infection Control and Epidemiology, June 2014. http://www.jstor.org/stable/info/10.1086/676023

2. “Clostridium difficile: Not Just in Hospitals Anymore,”Infection Control Today, June 2014 http://www.infectioncontroltoday.com/news/2014/06/clostr idium-difficile-not-just-for-hospitals-anymore.aspx

3. “AntibioticResistanceThreatsintheUnitedStates,”CentersforDiseaseControlandPrevention,April2013.

http://www.cdc.gov/drugresistance/threat-report-2013/4. “Gut Infections are Growing More Lethal,” New York

Times, March 2012. http://www.nytimes.com/2012/03/20/health /gut-infections-are-growing-much-more-lethal.html?pagewanted=all&_r=2&

What You Should Know about Methicillin-resistant Staphylococcus aureus (MRSA)

What is MRSA?MRSA is a form of staph infection resistant to

antibiotics. In a medical environment, MRSA causeslife-threatening bloodstream infections, pneumoniaand surgical site infections. Those infected in theircommunitiestypicallysufferseriousskininfections.

Is MRSA fatal?Data onMRSA fatalities is uncertain due to variables

in reporting. According to the CDC, there were 94,360MRSA infections in theU.S. and 18,650 deaths in 2005.TheNationalQualityMinorityQuality Forum estimatedin 2010 that there were 90,000 deaths attributable toMRSA.

Who’s in danger?A recent review of healthcare workers in Europe and

theU.S.concluded that4.6percentofhealthcareworkersand6.9percentofnursescarry,andcantransmit,MRSA,while not necessarily getting sick themselves. MRSA isparticularly troublesome inhospitals,prisonsandnursinghomes. It also spreads in locker rooms, schools and day

care centers. Data does not exist on the number of skininfectionscausedbyMRSAin thecommunity,accordingtotheCDC.

Has there been any progress fighting MRSA?MRSA is spreading from healthcare settings to the

generalcommunity,anditsresistancetoantibioticsgrowsstronger. With a national goal to reduce MRSA by 25percent,casesdeclinedonlyfourpercent.

Sources1. “Methicillin-resistant Staphylococcus aureus: Where is

it Coming From and Where is It Going?” Journal of the American Medical Association, November 2013. http://archinte.jamanetwork.com/article.aspx?articleid=1738714&resultClick=3

2. “Review ofMRSACarriageAmongHealthcareWorkers inNon-outbreak Settings in Europe and the U.S.,” Infection Control Today, July 2014. http://www.infectioncontroltoday.com/news/2014/07/review-of-mrsa-ca r r iage-among-healthcare-workers-in-nonoutbreak-settings-in-europe-and-us.aspx

3. “MappingMRSA,”NationalMinorityQualityForum http://www.mapmrsa.org/mrsa_facts.html4. MayoClinic http://www.mayoclinic.org/diseases-conditions/mrsa/basics/

definition/con-200244795. CentersforDiseaseControlandPrevention http://www.cdc.gov/mrsa/6. MRSASurvivorsNetwork http://www.mrsasurvivors.org/statistics7. StopMRSANow http://www.stopmrsanow.org

What You Should Know about Toxic Disinfectants

• ResearchersfromtheU.S.CentersforDiseaseControlNational Institute of Occupational Safety and Health(NIOSH) found that pregnant nurses exposed to toxicdisinfectants and sterilants were twice as likely tosuffermiscarriages.

http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS0002937811024707.main-abr.pdf?jid=ymob

• PracticeGreenhealthwarnsthatEthyleneOxide(EtO),a common medical disinfectant, is a known humancarcinogenand is linked toa long listofhealth issuesincludingproblemswiththeneurological,reproductive,nervous and respiratory systems. It can damagethe liver and kidney and cause cataracts. It is alsoflammable.

https://practicegreenhealth.org/topics/chemicals/sterilants-disinfectants

• Hospitals and healthcare facilities should considerthe environmental impact of cleaning products anddisinfectants,andmoreresearchisneededtodocumentthehealtheffectsof toxicproductsonworkers.HealthCareWithoutHarm,GlobalHealth&SafetyInitiative,the Lowell Center for Sustainable Production at theUniversity of Massachusetts and the UIC Schoolof Public Health review the patient, worker andenvironmentalissuesassociatedwithtoxicdisinfectantsand cleaners and recommend a systems approach for“greeningthecleaning.”

http://www.sustainableproduction.org/downloads/CleaninginHealthcareFacilities.pdf

• FacilityCare, a website for health facility managers,reviewsstudiesthatlinksurfacedisinfectantstoillnessamong healthcare workers. Nurses and housekeepers/custodiansexperiencethehighestrateofillness.HMIS(health and safety risk) ratings are explained andfacilitiesmanagersareencouraged tousedisinfectantswiththelowestpossiblerating.

http://www.facilitycare.com/environmental-services/use-disinfectants-healthcare-minimizing-their-health-impact-staff-and

• TheEPA’sHealthcareEnvironmentalResourceCenterwarns about the harmful effects of sterilants and

What You Should Know continued on page 14

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LegislativeEndorsement

Committee 2014Members of the Endorsement Committee are

established in Bylaws and appointed by the President.The Committee is made up of five board members andfivemembers with extensive legislative experience. TheCommittee has an equal number of Democrats andRepublicans members. The Committee meets by emailandmusthaveatleast7membersinfavorof,toendorseacandidateoranissue.

The following endorsements were made for the 2014 Elections:

OpposePropositions45and46.

Support CA Senate Candidates:MarcLevine(Incumbentwonprimary)MaryHayashi(lostprimary)MikeMcGuire(wonprimarySamKangAD-15(lostprimary)MarkJohanessenAD7(lostprimary)AssemblymanPan(wonprimary)

Endorsement of ANA\C members running for Local Office:

SusanAdamsforSupervisor(lostelection)SheilaAllenforCityCouncil(lostelection)

ANA\C endorses candidates for Congress inconjunction with ANA. ANAwill review, interview andthenselectcandidates to send toCalifornia that they feelareagoodmatch.ANA\Cthendeliberatesandadecisionismade toeitherendorseornotendorse thecandidate(s),ANA is notified and then moves forward to supportANA\Cendorsedrepresentatives.

US CongressIncumbents (member already holding office)

LoisCapps,RN(D),CD24—SanLuisObispo,SantaBarbaraandpartofVenturaKarenBass(D),CD37—PartofLosAngelesBarbaraLee(D),CD13—PartofAlamedaandSanFranciscoZoeLofgren(D),CD19—PartofSantaClaraLucilleRoybal-Allard(D),CD40—PartofLosAngelesMarkTakano(D),CD41—PartofRiverside

Candidate:PeteAguilar(D),CD31-SanBernardino

Save the Date!!

ANA\C RN Day 2015 – A Day at the Capitol

Sacramento, CA

Monday April 13th 2015

Registration and program information can be found on

the web site (soon) at www.anacalifornia.org

CA Court Ruling Favors Nursing Profession’s Input*SILVER SPRING, MD* – The American Nurses

Association(ANA)claimsarecentlegalvictory-ensuringthat registered nurses (RNs) will have an opportunityto express their concerns when California’s educationdepartmentproposesregulatorychangesthataffectschoolandotherRNs.

The ruling is significant in underscoring the stateBoardofNursing’sauthorityinregulatingnursingpracticeand protecting against other agencies issuing regulationsthataffectnursingpracticewithouttheprofession’sinput.

“The nursing profession is committed to vigorousself-regulation to ensure provision of safe and high-quality care,” saidANAPresidentKarenA.Daley, PhD,RN, FAAN. “It’s a dangerous practice to allow otherprofessions to make unilateral decisions about how toprovide safehealthcare services that fallundernursing’sresponsibilities.Thecourtmadeawise ruling in thebestinterestsofnurses,studentsandpatients.”

ACaliforniaappellatecourtagreedwithANAthattheCalifornia Department of Education violated state lawwhen it promulgated a new regulation in 2007 allowingunlicensed school personnel to administer insulinto students with diabetes. The education departmentissued the regulation without giving nurses and otherstakeholdersnoticeandachance tocomment,aviolationofCalifornia’sAdministrativeProceduresAct,whichsaysno regulation can be enacted without such notice and acommentperiod.

The education department’s 2007 regulation rancounter to longstanding positions published by boththe department and the California Board of RegisteredNursing that said unlicensed school employees could notadministerinsulin.

California’s Nursing Practice Act provides thatadministering medication is a nursing function and theNursingPracticeActprohibitsunlicensedindividualsfromengaginginthepracticeofnursing.

In a related decision, the California Supreme Courtruled in favor of the American Diabetes Association in2013 to allow unlicensed personnel to administer insulinto students, overriding two lower courts that ruled thatthe practice was an unlawful violation of the NursingPracticeAct’s prohibition against the unlicensed practiceofnursing.

The current ruling by the California appellate courton requirements to provide notice and opportunity forcomment does not affect or overturn the CaliforniaSupreme Court’s decision allowing unlicensed personneltoadministerinsulintostudents.

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There is more than one proposition on the California ballot this November thatthreatenspatientsand thecaregivers thatprovide their care.Proposition45wouldgiveone single state politician in Sacramento vast new powers to interfere with medicaldecisionsthatarebestmadebetweennursesandpatients.

Proposition45wouldgivetheelectedstateInsuranceCommissionernewpowerovernotonlyhealthcarerates,copaysanddeductibles,butalsosweepingauthorityoverthebenefitsincludedinhealthplans.

The American Nurses Association\ California is part of a broad coalition opposedtoProposition45,alongwith theCaliforniaMedicalAssociation,CaliforniaChildren’sHospital Association, and dozens of countymedical and specialty societies, hospitals,healthplans,andsmallbusinesses.

ANA\C Executive Director, Tricia Hunter explained why so many provider groupsareopposingProp.45:“Proposition45threatensnurses’abilitytoprovidethecarethatpatientsneedbygivingasingleelectedpolitician–theInsuranceCommissioner–vastnewpower over our health care.The last thingwe need is a state politicianmeddlingwith decisions about the care and benefits patients receive.We’ve seen the disastrouseffectsofstatebureaucratsgettinginvolvedinhealthcare.ANA\CaliforniaurgesnursesandallvoterstoopposeProp.45.”

Prop. 45 alsohas a hidden agenda– allowing trial lawyers and the sponsors to filecostlynewhealthcarelawsuits.Theyburiedaprovisioninthefineprintthatfinanciallyincentivizes them to “intervene” in the regulatory process created under the Initiative.Prop.45allowstheselawyerstopocketmillionsofdollarsinso-called“intervenerfees”–earningasmuchas$675/hour.Infact,theproponentshavealreadyreceivedmorethan$11.5millionfromasimilarprovisionusedinapreviousmeasuretheywrote.

Many business groups and taxpayer organizations also oppose Prop. 45 because itsetsupacostlyandduplicativenewbureaucracy,whenCaliforniaalreadyhasmultipleregulatorsoverseeinghealthcare.

Lastly, Prop. 45 establishes new and conflicting rules that could interfere withCalifornia’s implementation of theAffordable CareAct – providingmore uncertainty,delaysandconfusionata timewhenCalifornianursesandpatientsarealreadydealingwithmassivechangestoourhealthcaresystem.

FormoreinformationortosignuptoopposeProp.45visitwww.stophighercosts.org.

Proposition 45 - Puts a State Politician in Charge of Your

Patients’ Health Care

Legislative

The History of ANA\CA and MICRA

WhilemuchofthebuzzthisyearisaboutdefeatingProposition46,thetriallawyer-sponsoredmeasurethatwouldchangeCalifornia’sMedicalInjuryCompensationReformAct (MICRA), theAmericanNursesAssociationCaliforniahasbeenworkingonyourbehalftoprotectMICRAformorethanadecade.

ANA\CA joined the Board of Californians Allied for Patient Protection (CAPP), the organization dedicated to protecting MICRA from any legislative attacks, in 1998.Over thepast16years,ANA\CAhasworked tirelesslyalongside theother900+CAPPcoalitionmemberstoprotectaccesstocarethroughMICRA.

Why MICRA WorksToday,MICRAensures injuredpatientsareprotectedandfairlycompensated,while

also limiting frivolous lawsuits. MICRA’s limits on meritless lawsuits keeps medicalliabilityrateslower,allowingmoredoctors,nursesandotherhealthcareproviderstostayinpracticeandallowingmorehospitalsandclinicstostayopen.

PriortoMICRA,Californiawasincrisis.Out-of-controlmedicalliabilitycostswereforcing health care providers out of practice.An excerpt from a story in the San JoseMercuryNewsatthetimesumsupthecrisis:

“Premiums have reached the point that some physicians are leaving California orretiring from active practice and some other physicians in high-risk categories areunabletoobtainliabilityinsurance.”

MICRA stabilized liability costs, thus protecting specialty and high-risk providers,includingwomen’shealthcare,communityclinics,healthcentersandruralprovidersthatcanleastaffordskyrocketinginsurancecosts.

NotonlydoesMICRAprotecthealthcareproviders,but italsoprotects thepatientsthey serve. MICRA preserves patients’ access to fair compensation when they havejustifiableclaims,including:

MICRAlimits theamounta lawyercan takeaspaymentforrepresentingan injuredpatient.Thisensuresmoremoneygoestopatients,nottheirlawyers.

MICRA Under AttackMICRA has saved health care consumers billions of dollars by protecting against

meritlesslawsuits.Notsurprisingly,MICRAisthetargetofCaliforniatriallawyerswhowanttochangethelawtomakeiteasierandmorelucrativetofilelawsuits.TriallawyersandtheiralliescontinuetotrytochangeMICRAinthelegislatureeveryyear,andhavenowplacedProp.46ontheNovember2014ballot.Thechangestheycontinuetoseek?

• Triallawyerswanttoquadruplethenon-economicdamagesawardfrom$250,000tomorethan$1.1million!

• Simply doubling the amount of non-economic damages allowed under MICRAwillraise health care costs in California by a whopping $9.5 billion annually,according to a report by the State’s former non-partisan Legislative AnalystWilliamHamm. Increasing the amount by four times asmuch, as trial lawyerswanttodo,willincreasecostsevenmore.

• AnychangestoMICRAtoweakenitsprotectionswillresultinhigherhealthcarecostsoverall,noimprovementinquality,andreducedaccesstoservices.

ANA\CAwillcontinueadvocatingwiththeCAPPcoalitionmembers,whichincludeshospitals, community clinics, health centers, physicians, emergency providers, dentists,public safety, local governments, women’s health advocates and others against anylegislativeattacksonMICRA.FormoreaboutCAPP,visitwww.micra.org.

Additionally,ANA\CAhasalsojoinedtheNoOnProp.46coalitionandwillcontinueto keep you updated on efforts to defeat the November ballot measure. For moreinformation,visitwww.NoOn46.com.

Economicdamagesforallpastandfuturemedicalcosts.

Economic damages for lost wages, lifetime earning potential and for anyotherconceivableeconomiclosses.

Punitivedamages,whichseektopunishadefendant.

Upto$250,000availablefornon-economicdamages,sometimescalledpainandsufferingawards.

Do you wish that you could make a bigger impact on nursing with your expertise in a certain area?

The American Nurses Association/California is looking for your expertise to serve in a directional position.

Applytodayathttp://www.anacalifornia.org/formembershipandtorunforaboardpositionthatcanshowcaseyourexcellenceinnursingpractice,nursingeducation,legislativeadvocacyormembership

growthandretention.

It is to make your voice for nursing louder, stronger, and reverberate statewide.


The American Nurses Association California haspartnered with a large and diverse coalition includinghealth care providers, community clinics and healthcenters, laborunions,businessand taxpayergroups, localgovernment and community groups to defeat Proposition46 on the November ballot. If passed, Prop. 46 willincrease health care costs, jeopardize people’s ability tosee their trusted health care providers, and threaten theprivacyofpersonalprescriptiondruginformation.

Get The Facts

What will Prop. 46 do?1. Quadruples the MICRA limit on medical

malpractice awards in California, which will costconsumers and taxpayers hundreds of millionsof dollars every year in higher health care costs,and cause many doctors and other medical careprofessionalstoquittheirpracticeormovetoplaceswithlowermedicalmalpracticeinsurancepremiums–reducingaccesstocare.

2. Threatens people’s privacy by requiring a massiveexpansionoftheuseofapersonalprescriptiondrugdatabase.

3. Requiresalcoholanddrugtestingofdoctors,whichwasonlyaddedtothisinitiativetodistractfromthemainpurposeofchangingMICRA.

Who opposes Prop. 46?Thousands of organizations and individuals

representing nurses, doctors, community clinics, localgovernments, labor unions, business groups, educationgroups,taxpayergroups,hospitals,communitygroupsandmanyothersopposeProp.46becauseitwillleadtomorelawsuits,higherhealthcarecosts,threatenpeople’saccessto their trusted health care providers, and jeopardizepeople’spersonalprescriptiondruginformation.

Who supports Prop. 46?One hundred percent of the reported contributions to

pay for signature gathering to place this on the ballot inNovember2014camefromtriallawyersandtheirallies.

Why are community clinics so strongly opposed to Prop. 46?

Communityclinics,likePlannedParenthoodAffiliatesof California, Community Clinic Association of Los

Angeles County, the California Association of RuralHealth Clinics and hundreds of others say Prop. 46willraise costs and will cause specialists, like OBGYNs, toreduceoreliminateservicestotheirpatients.Manyclinicsstruggle financially, particularly community clinics thatservelow-income,uninsuredandruralpatients.Anythingthat increases costs could jeopardize access to care forthosepatientsmostinneed.

How will Prop. 46 increase health care costs?There is no question thatmore lawsuits against health

careprovidersandmorelucrativepayoutsfortriallawyerswill increase costs, and someone has to pay. And thatsomeoneisconsumersandtaxpayers.

California’s formerLegislativeAnalyst foundProp.46wouldincreasehealthcostsforconsumersandthestatebyabout$9.9billionannually.This translates to more than $1,000/year in higher health care costs for a family of four.

California’s current independent, non-partisanLegislative Analyst’s Office (LAO) said impacts tostate and local governments (i.e. – taxpayers) could be“hundredsofmillionsofdollarsannually.”

Inevaluatingthemeasure,theLAOsaid:“…the higher cap on noneconomic damages could increase the number of medical malpractice lawsuits filed against health care providers. In response, some health care providers, such as physicians, may change their behavior in an effort to avoid having a lawsuit filed against them. …For example, a physician may order a test or procedure for a patient that he or she would not have otherwise ordered.”

The LAO continues, “…policies that increase the likelihood of a provider being sued for malpractice, such as raising the cap on noneconomic damages, would likely encourage the provision of different amounts of services that, on net, increase health care costs.”

In its evaluation, the LAO warned “even a small percentage change in health care costs could have a significant effect on government health care spending.”

Here’s How You Can Get Involved

Please join with ANA\CA and become an officialmember of the No on Prop. 46 campaign. Visit thecampaignwebsite,www.NoOn46.com,to:

• Sign up to add your name to the growing list ofindividualsandgroupsopposedtoProp.46

• Get important facts, downloads and informationthatwillhelpyouspreadthewordaboutthiscostlymeasure

• Checkoutthelist of groups opposedtoProp.46• Contribute toNoonProp.46tohelpfight the trial

lawyers• Request pamphlets, buttons and posters that

can help educate your patients about the negativeimpactsofProp.46.Thesematerialsareperfectforyourofficelobbiesorexamrooms.

• Followusonsocial media¡Twitter:@NoOn46¡Facebook:Noon46

We Need Your Help Educating Voters About Prop. 46!

No one knows more about health care and patientsafety, or is more trusted, than health care professionalslike you. That iswhywe need your help to explainwhyProp. 46 is bad policy that will increase costs, reduceaccess to care and jeopardize the privacy of people’spersonalprescriptiondruginformation.Thecampaignhaspamphlets, posters andbuttons for display in your lobby/waitingroomstoeducatevotersaboutproblemswithProp.46.Pleasesign up online ifyouareinterestedinbeingapartofthisprogramtodisplaythesematerials.

Increased costs. Losing your doctor.

Threatening your privacy. Exactly what happens when trial lawyers play doctor.

• Nurse Managers/Health Wellness Directors (LVNs or RNs)

• Regional Nurse Directors (RNs)

Northern California

Contact Sindhu Nair: [email protected]


disinfectants and recommends guidelines for the safe handling and disposal of these dangerous chemicals.

http://www.hercenter.org/hazmat/steril.cfm

• Health Care Without Harm encourages healthcareproviders to use safer alternatives that stop infections and don’t threaten the health of workers or the environment.

https://noharm-uscanada.org/issues/us-canada/cleaners-and-disinfectants

• HealthCareWithoutHarm lists “TenReasons toBanGlutaraldehyde.”

ht tps://noharm-uscanada.org/sites/default /f i les/documents-files/61/10_Reasons_Glutaraldehyde.pdf

• Both chronic and acute health effects are associatedwith the use of disinfectants in hospitals. In 2010, the Centers for Disease Control and Prevention (CDC)published a study of related illnesses from Californiaand three other states, identifying 401 acute cases of eye, neurologic and respiratory problems.

ht tp://www.cdc.gov/mmwr/preview/mmwrhtml /mm5918a2.htm

• Nurses and healthcare workers experience increasedrates of occupational diseases, including asthma and other respiratory diseases related to their exposure totoxicdisinfectants.Thisarticlereviewstheresearch.

http://www.infectioncontroltoday.com/articles/2012/10/occupational-health-protecting-workers-against-chemical-exposures.aspx

What You Should Know to Protect Yourself

Roadmap to Engaging Patients & Families in HandHygiene. http://medicare.qualishealth.org/sites/default/files/medicare.qualishealth.org/Roadmap.pdf

Infectious Diarrhea Germs Stick to HealthcareWorkers’Hands. Society forHealthcareEpidemiologyofAmerica. December 23, 2013. http://press.uchicago.edu/pressReleases/2013/December/1223_iche_moore_germs.html

“Infection Prevention and You,” Association of Professionalsin Infection Control. http://www.apic.org/Resource_/T i n yMc e F i l eM a n a g e r / I P_ a n d _Yo u / I P a n dYo u _InfographicPoster_2013.pdf

“Compendium of Strategies to Prevent Healthcare-AssociatedInfections in Acute Care Hospitals,” Infection Control and Hospital Epidemiology, August 2014. http://www.jstor.org/stable/10.1086/677216

“Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals: 2014 Update,” Infection Controland Epidemiology, June 2014. http://www.jstor.org/stable/info/10.1086/676023

“MRSA and Healthcare Workers,” Occupational Health andSafetyAdministration (OSHA). https://www.osha.gov/SLTC/etools/hospital/hazards/mro/mrsa/mrsa.html

“MRSA:ProtectingStudentAthletes,”MayoClinic.http://www.mayoclinic.org/diseases-conditions/mrsa/in-depth/mrsa/art-20047876

“PreventingC. diff,”C.diffFoundation http://cdifffoundation.org/what-is-clostridium-difficile/“PreventionofC.diffInfections,”MayoClinic http://www.mayoclinic.org/diseases-conditions/c-difficile/

basics/prevention/con-20029664

Centers for Disease Control and PreventionFrequentlyAskedQuestionsaboutMRSA http://www.cdc.gov/mrsa/pdf/SHEA-mrsa_tagged.pdfFrequentlyAskedQuestionsaboutC. diff http://www.cdc.gov/HAI/pdfs/cdiff/Cdiff_tagged.pdfQuestionsandAnswersforHealthcareProviders http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_faqs_HCP.htmlMRSAinthe(non-health)Workplace http://www.cdc.gov/niosh/docs/2013-112/pdfs/2013-112.pdfMRSAandCorrectionalOfficers http://www.cdc.gov/niosh/docs/2013-117/pdfs/2013-117.pdfMRSAInformationforSchoolandDaycareOfficials http://www.cdc.gov/mrsa/community/schools/index.htmlMRSAintheCommunity http://www.cdc.gov/mrsa/community/index.html

About UsStopInfectionsSafely.org was created to keep patients,

healthcare providers, workers, first responders and environmentalists informed about healthcare-associated infections and the disinfectants used to stop them.

This site is sponsored by sBioMed, which manufacturesSTERIPLEX SD, an EPA-approved disinfectant that kills C.diff, MRSA and other HAI’s without bleach. STERIPLEXSD hasanHMIS(health andsafetyrisk)ratingof0andmeetsthecriteriaofEPACategoryIV,whichmeansnoprecautionarystatementsorfirstaidinstructionsarerequiredonitslabel.

For more information, please contact [email protected].

What You Should Know continued from page 10

Practice

New AHRQ Research Compares Impact of Efforts Aimed at Preventing Childhood Obesity

Through our partnership with the Agency for HealthcareResearchandQuality(AHRQ),AmericanNursesAssociation\California (ANA\C) is offering free resources on childhoodobesity prevention.

AHRQ’s Childhood Obesity Prevention Programs: Comparative Effectiveness Review and Meta-Analysis compared the effectiveness, risks, and benefits of 104 school-based interventions. A key finding is that there is moderate to high strength of evidence that diet and/or physical activity interventions implemented in schools help prevent weight gain or reduce the prevalence of overweight and obesity in children. AHRQ’s Effective Health Care (EHC) Program presentsthese findings in the following easy-to-read evidence-based materials for clinicians and consumers:

• Childhood Obesity Prevention Programs: Comparative Effectiveness, which summarizes the research findings to quickly give you the clinical bottom line.

• Keeping Children at a Healthy Weight, which helps patientsexploretreatmentoptionsonhowtokeeptheirchild from becoming overweight or obese, compare the benefits and risks of these options, and prepare to discuss these options with you.

AlsoavailableforhealthprofessionalsisaPowerPointslidepresentation titled “ChildhoodObesity Prevention Programs:Comparative Effectiveness,” and can be found on the EHCProgramWebsite:http://effectivehealthcare.ahrq.gov.

The EHC Program complements ANA\C’s efforts toimprovethequalityofhealthcareinourcommunities.AHRQcreates similar resources on13priority conditions, includingcardiovascular disease, diabetes, arthritis, and mental health disorders. Below are suggested ways to use these EHCProgramresources.

• Review the “Clinical Bottom Line” information andlearn about the strength of the evidence behind research findings.Sharetheresourceswithyourcolleagues.

• Display AHRQ’s new promotional videos in waitingrooms to help newly diagnosed patients, existingpatients, and caregivers understand the value of comparing treatment options.

• Distribute patient treatment summaries andalso encourage patients to visit www.ahrq.gov/treatmentoptions to learn more.

• Earn continuing medical education/continuingeducation (CME/CE) credits by participating in free,

AHRQ National Partnership Network Childhood Obesity Materials Promotional Copy

accredited CME/CE activities based on AHRQ’scomparative effectiveness research studies.

• Sign up to receive email updates on AHRQ’scomparative effectiveness research and EHC Programresources.

These free resources are available on the EHC ProgramWeb site. To order childhood obesity summaries, call 800-358-9295. Ask the Publications Clearinghouse for AHRQPublication13-EHC081-Aforthepatientsummary,“KeepingChildren at aHealthyWeight”, and Publication 13-EHC081-3 for the clinician summary, “ChildhoodObesity PreventionPrograms:ComparativeEffectiveness.”

Facebook Posts for Clinician Audiences • The Agency for Healthcare Research and Quality’s

Effective Health Care Program has free resources onchildhood obesity prevention. These clinician andpatient resources quickly give you the clinical bottom line and help your patients explore treatment options for their and their loved ones’ health conditions, compare the benefits and risks of each, and prepare to discuss themwithyou.Visithttp://go.usa.gov/56l to download these free resources.

• According to the CDC, 12.5 million children (ages2-19) are obese in the U.S. In partnership with theAgencyforHealthcareResearchandQuality,AmericanNurses Association\California (ANA\C) is offeringfree, evidence-based resources on childhood obesity prevention.Withtheseresources,youandyourpatientscan work together to decide which treatment option is best.Visithttp://go.usa.gov/56l to download these free resources.

• Childhood obesity continues to be a serious problemin the U.S., as approximately 17% of children (ages2-19) are obese. TheAgency forHealthcare ResearchandQuality’sEffectiveHealthCareProgramhasnew,free resources on childhood obesity prevention to help your patients explore treatment options, compare the benefits and risks of each, and prepare to discuss them with you.Visithttp://go.usa.gov/56l to download these free resources.

Professional Organization Tweets

• Download @AHRQNews #childobesity resources toexplore, prepare, and compare your treatment options:http://go.usa.gov/56l

• Get free, unbiased @AHRQNews resources on#childobesity and explore your child’s treatmentoptions: http://go.usa.gov/56l

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Practice

Dr. Elizabeth J. Wider, EdD, MSN, RNANA\C Member and Assistant Professor National

University, Los Angeles Campus

In the1960s, theshortagesofprimarycarephysiciansled to the development of the nurse practitioner (NP)role. The University of Colorado was the first academicinstitutiontoeducateregisterednursesintheNPexpandedrole.Morethan300nursepractitionerprogramsexittoday.

During the 1960s, the role of the NP was intendedto care for the underserved as primary care providers(Fletcher,Copeland,Lowery,&Reeves,2011).Today,theshortage of primary care physicians and the launchingof the Affordable Care Act have rejuvenated discourseregardingthescopeofpracticeoftheNPasprimarycareproviders. The focus of this paper is to examine theNPscope of practice, barriers to autonomy for the NP, andtheeffectivenessandefficiencyoftheNPasprimarycareproviders.

California Senate Bill No. 491, introduced by SenatorHernandez on February 21, 2013 sought to increase thelevel of autonomy for NPs who provide care in a clinic,healthfacility,countymedicalfacility,accountablehealthcareorganizations(ACOs),orgrouppractice(Hernandez,2013).TheprovisionsofthebillincreasetheautonomyoftheNP topracticingwithoutphysician supervision in theabove mentioned healthcare systems after the NP “haspracticedunder thesupervisionofaphysicianforat least4160hours”(Hernandez,2013,p.1).ThebillwouldallowNPs to independently order durable medical equipment,perform physical exams, modify plan of treatment forclients receiving home health services, order hospicecare, manage physical and psychosocial health, establishadiagnosis,order, furnish,orprescribedrugsordevices,and delegate tasks to a medical assistant. Currently, thelevelofindependenceforpracticingNPsvariesfromstatetostate.

California is one of 24 states that require physicianinvolvement forNPs to diagnose, treat, and prescribe forpatients.IntheUnitedStates,16States(Alaska,Arizona,Colorado, Iowa, Idaho, Maryland, Maine, Montana,North Dakota, New Hampshire, New Mexico, Oregon,Rhode Island, Vermont, Washington, and Wyoming)legislateNPs topractice independentlywithoutapracticeagreement with a supervising physician (Iglehart, 2013).Senate Bill 491 would advance the scope of practice forNPs toward the level of independence asserted by NPsin the neighboring states of Arizona and Oregon. Theregulatorybarriers,relatedtotheNPscopeofpracticeareverycomplex.

According to Safriet (2011) the complexity of theregulatory barriers is an uncoordinated scheme of bothprescriptiveandincentivizedregulationsatthestate,local,and federal levels. Furthermore, “these governmentalregulations are further compounded by the credentialingand payment policies of private insurers and managedcare organizations” (Safriet, 2011, p. 446).The twomostexplicit restrictive categories resulting from the complexand uncoordinated regulatory schemata are the statelevel limitations on the NP scope of practice and thereimbursement policies that exist for both private andpublic entities. The state level limitations on the scope

Nurse Practitioners as Primary Health Care Providers: Scope of Practice, barriers to autonomy, and effectiveness and efficiency of the NP as primary care providers

ofpracticepreventNPs frompracticing to the full extentof their abilities (Iglehart, 2013; Safriet, 2011; Riegel,Sullivan-Marx, & Fairman, 2012; Buerhaus, 2010). Thereimbursement policies either render NPs ineligible forpayment,orexcludeNPsfrombeingpaiddirectly,orpayNPsatadiscountedrateforthesameservicesprovidedbyaphysician (Iglehart,2013;Safriet,2011).The regulatoryandreimbursementpoliciesarenowbeingrevisitedbasedon the increased need for primary healthcare providersand because NPs have demonstrated to be effective andsafeprimarycarepractitioners.

The Institute of Medicine (IOM) (2011) recommendstheremovalofscope-of-practicebarriersthatlimittheNPfrom practicing to the full extent of their education andtraining. Substantial evidence support the effectivenessof NPs as primary care providers (Buerhaus, 2010;Fletcher, Copeland, Lowery, & Reeves, 2011; Safriet,2011;Horrocks,Anderson,&Salisbury,2002;Instituteofmedicine, 2010).Naylor andKurtzman (2013) foundNPsprovideanequallevelofcareprovidedbyphysicians.Datareviewed between 1990 – 2008 indicate NPs, “provideeffectiveandhigh-qualitypatientcare,havean importantrole in proving the quality of patient care in the UnitedStates, and could help address concerns about whethercare provided by APRNs [NPs] can safely augmentthe physician supply to support reform efforts aimed atexpanding access to care” (Newhouse, Bass, Steinwachs,Stanki-Hutt,Zangaro,Heindel,etal,2011,p.247).LevinandBateman(2011)sightvarioussourcesthatsubstantiatetheNPsdelivercare that isequal to thatof thephysicianand 80% of what the physicians do can be competentlyhandledbyNPs.

The latest action for the California Senate Bill No.491 tookplaceonAugust 30, 2013 and thebillwasheldin committee and under submission. According to theAssociation of American Medical Colleges (AAMC)(2012) an estimated 32 million Americans will becomenewly insuredunder theAffordableCareActandpredictby 2020 a shortage of 90,000 doctors. According to theBureau of Labor Statistics (2012) approximately 105,780nurse practitioners are employed across the nation today.The300nursepractitionerprogramscontinuetograduatehighly qualified NPs who if allowed to practice at theirfull education and training as effective and efficientprimarycareproviderscanmeetthepredictedhealthcareneeds resulting from theAffordableCareAct. Increasing

healthcare services across the nation is an importantaspect of the Affordable Care Act, whereby the NP asprimarycareproviderscanplayasignificantrole.

References:Association of American Medical Colleges (AAMC). (2012).

AAMC Physician Workforce Policy Recommendations.Retrieved fromhttps://www.aamc.org/download/304026/data/2012aamcworkforcepolicyrecommendations.pdf

Buerhaus, P. I. (2010). Have Nurse Practitioners Reached aTippingPoint?InterviewofaPanelofNPThoughtLeaders.Nursing Economics$,28(5),346-349.

Bureau of Labor Statistics. (2012). Occupation: NursePractitioners (SOCcode 291171).Retrieved fromhttp://data.bls.gov/oes/datatype.do

Flectcher, C. E., Copeland, L. A., Lowery, J. C., and Reeves,P. J. (2011). Nurse Practitioners as Primary Care ProvidersWithin the VA. Military Medicine, 176 (7), 791 – 797. IP:203.56.241.121

Horrocks, S., Anderson, E., 7 Salisbury, C. (2002). Systematicreview of whether nurse practitioners working in primarycarecanprovideequivalentcaretodoctors.BMJ,324:819–823.

Iglehart, J. K. (2013). Expanding the Role of Advanced NursePractitioners – Risks and Rewards. The New England Journal of Medicine,368(20),1935-1941.

Institute ofMedicine. (2010).TheFuture ofNursing:Focus onscopeofpractice.Retrievedfromwww.iom.edu/nursing.

IOM (Institute of Medicine). 2011. The Future of Nursing: Leading Change, Advancing Health.Washington, DC: TheNationalAcademiesPress.

Levin,P.J.,&Bateman,R.(2011).Organizingandinvestingtoexpand primary care availability with nurse practitioners.J Community Health,37:265–269.doi:10.1007/s10900-011-

9537-5Newhouse, R.P., Bass, E. B., Steinwachs, D. M., Stanki-

Hutt, J., Zangaro, G., Heindel, L., White, K. M., Wilson,R. F.,Weiner, J. P., johantgen,M., and Fountain, L. (2011).AdvancedPracticeNurseOutcomes 1990–2008:ASystematicReview.Nursing Economics$,25(5):230–250.

Riegel, B., Sullivan-Marx, E., and Fairman, J. (2012).Meetingglobal needs in primary care with nurse practitioners. The Lancet,380:449–450.

Safriet,B.J. (2011).FederalOptions forMaximizing theValueof Advanced Practice Nurses in Providing Quality, Cost-Effective Health Care. Committee on the Robert WoodJohnson Foundation Initiative on the Future of Nursing, atthe Institute ofMedicine; Institute ofMedicine. (2011).TheFutureofNursing:LeadingChange,AdvancingHealth.The National Academies Science.

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Practice

Hon. Tricia Hunter, RN, MN

InOctober2013, theDepartmentofConsumerAffairsimplemented a new computer program for licensees inCalifornia.TheBoard ofRegisteredNursing (BRN)waschosen as one of the first licensing boards to implementthesystem.TheBRNisonlysecondtotheRealtorBoardinthenumberoflicenseestheyoversee.

BreEZe is supposed to be an all encompassing onlineprogram. It is suppose to incorporate enforcement andlicensing to support tracking, licensing renewal, andenforcementmonitoring,cashieringanddatamanagementactivities.ItisbeingimplementedinthreephaseswiththeBRNinthefirstphase.

Many of you may have experienced issues with therenewal process with the BRN or when registeringas a new graduate for the NCLEX-RN examination.California Legislators offices as well as the BRN havebeen inundated with calls from student nurses, nursestrying tomove toCalifornia,nurseemployersandnursesrenewing their license. Though some of the issues havebeen resolved, it is taking longer for theBRN toprocesslicenses.Whatuse tobecompleted ina30dayperiod isnow taking at least sixweeks and could take as long astwomonths. Unlike most websites, the BreEZe programdoesnot tellyouwhatwasenteredincorrectlyor identifymissingitemsthatneedtobecorrected;itjuststopsyouinyour tracks. Ipersonally experienced thiswhile trying torenewmylicenserecently.

Update on the Board of Registered Nursing and the New Computer System:

Audit of the Board of Registered Nursing BreEZe Implementation

TheBRNhasincreasedthenumberofpersonsintheircallcenterplus theDepartmentofConsumerAffairscallcenter has been accepting calls on behalf of the BRN.Though this has helped with getting the calls answered,misinformationhasbeenprovidedtomanyofthepersonscalling in. However, it is taking many more steps toprocess items so additional staff has been needed for allthefunctionsofBreEZe.TheexistingstaffoftheBRNhasputinmanyhoursofovertimetryingtokeepupwiththeworkload.

The Joint Legislative Audit Committee of theLegislature is made up of members of the Senate andAssembly. The Chair and Vice Chair rotate each yearbetweenthetwohouses. AnauditmustberequestedbyaLegislatorandapprovedbythecommittee.AnauditofficeoftheStateAdministrationrespondstotherequestoftheLegislatorwithasummaryofwhattheycando;howmuchitwillcost;andhowlongitwilltake.

OnJuly1,2014theJointLegislativeAuditCommitteeheard a request from Assemblymember Olsen to auditthepoliciesandproceduresassociatedwith theplanning,development, and implementation of the BreEZe onlinesystem for licensing and enforcement by the CaliforniaDepartmentofConsumerAffairs.

AssemblymemberOlsenrequestedanauditto:• review the process of planning developing and

implementing BreEZE including the level ofoutreach provided to stakeholders and adequacyoftrainingprovidedtostaff

• reviewwhyBreEZewasselected

• evaluatewhetherDCAprovidedsufficientoversightand testing during the planning, development andimplementation of BreEZe including whetherthe executive office was involved in making keydecisionsensuringthatBreEZemettheneedsoftheBRN

• review and evaluate all contracts and amendmentsas towhether theyhave beenmet andwhether theStatehasadequaterecourseintheeventthatBreEzevendors and developers did not fulfill contractrequirements

• determine theestimatedandactual implementationtimelineaswellascosts

• determineandevaluatethedesignandrequirementsimpact on theBoards implementation timeline andbusinessprocesses

• The review is to determine whether BreEZemodified its processes or did the BRN have tomodifyitselftofitBreEZ

• determinehowlongittooktoprocessalicensepreBreEZeandpostBreEZe

• assess the current backlog and determine whatcontingencyplanswereinplace

Thisauditwillbecompletedby theendof Januaryor

thefirstpartofFebruary2015.TheBRNandDepartmentof Consumer Affairs supported the audit. ANA\CtestifiedinsupportoftheauditalongwithPatMcFarland,Executive Director of Association of California NurseLeaders (ACNL) and the California Student NursesAssociation(CSNA).

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ANA\California Calendar of Events

AllANA\Cmembersarewelcomeandencouragedtoattendmeetingsof theBoardofDirectors.MeetingsareheldinSacramentoattheANA\CofficelocatedinTheSenatorOfficeBuilding,1121LStreet,Suite508,Sacramento,CA.95814.Meetings begin at 10:00 am. unless otherwise noted.Anymember interested in attending aBoardmeeting isasked to notify theANA\C staff at least oneweek prior to themeeting date by calling 916-447-0225.Memberswillreceiveinstructionsforparkingandentryintotheofficebuildingatthattime.

September 2014

20th–27thNurse Executives Delegation to Costa Rica; Sponsored by People to People Citizen AmbassadorProgramsVisitfacilities,experienceinformationsocialeventsandroundtablediscussionswithfellownursesTolearnmorevisitwww.peopletopeople.com/AONEorcall877.787.2000

30th LastdayforCAGovernortosignorvetoallbills

October 2014

8th-10th Magnet Conference® Dallas, TX for more information visit http://www.nursecredentialing.org/MagnetConference

17th–19th CNSAConvention, SheratonFairplexHotelandConventionCenterPomonaCalifornia

November 2014

1stThe Nursing Voice – Article submission deadline - For information about submitting and article,pleaseseepage2ofthisnewsletterforTheNursingVoice‘ArticleSubmissionGuidelinesorcall916-447-0225.

4th–5th 2014ANAStaffingConferenceHyattRegencyNewOrleans,NewOrleans,LAformoreinformationgotowww.nursingworld.org

5th ‘Consent to Serve’ forms will be accepted up until 11:50 PM this date for the 2015-2017 election period to be voted on by membership beginning December 3rd 2014

6th–9th NSNAMid-YearConference,HiltonPortland&ExecutiveTowerPortlandORformoreinformationgotowww.nsna.org

10th–14th ACNLFoundationforLeadershipExcellence,EmbassySuites-AnaheimSouth,GardenGrove,CA92840formoreinformationgotowww.acnl.org

12th ANA\C2ndQtrFinancialReview

December 2014

1st NewCALegislatureswornintooffice

3rd Onlinevotingopens for the2015-2017electionofOfficersandDirectors forANA\C,paperballotswillbemailedtoallwhodonothaveemailaddressonfilewithANA\C

5th ANA\CBoardofDirectorsMeetingSacramentoCAmeetingwillbeginat10:00am

13th ANA\CBoardMeetsattheLAAirportHilton

11th–14th ACNL&CINHC–BuildingaFoundationforLeadershipExcellence

January 2015

5th Legislaturereconvenes

28th Closeof the2015-2017onlinevoting; resultswill bepostedonline, in thenewsletterorby calling916.447.0225

28th ANA\C3rdQtr.FinancialReview

February 2015

1stThe Nursing Voice – Article submission deadline - For information about submitting and article,please see page2of this newsletter forTheNursingVoice ‘ArticleSubmissionGuidelines’ or call916-447-0225.

4th–6th ANAQualityConference,On the Frontline of Quality: The Future of Health Care,DisneyCoronadoSpringsResort,OrlandoFLformoreinformationgotowww.nursingworld.org

18th ANA\C3rdQtrFinancialReview

March 2015

6th–7th 2013-2015BoardmeetingandBoardandBallotCommitteeOrientation,SacramentoCA

April 2015

8th–11th NSNA63rdAnnualConvention,PhoenixConventionCenter,Phoenix,AZ,BrightHorizons:RisingtoNewOpportunities

13th RNDay –A day at the Capitol, Sacramento CA, LegislativeHowTo program for all nurses andstudentnurses.Formoreinformationgotowww.anacalifornia.orgorcall916-447-0225

May 2015

1st The Nursing Voice–Articlesubmissiondeadline-Forinformationaboutsubmittingandarticle,pleaseseepage2ofthisnewsletterforTheNursingVoice‘ArticleSubmissionGuidelinesorcall916-447-0225.

In this election year the Endorsement Committee is hardat work evaluating the requests from candidates runningfor State office asking ANA\C for support during theircampaigns.There are ten (10)ANA\Cmembers representingyouonthiscommittee.

The Legislative Committee oversees the tracking ofbills before the State legislature and designates support/watch/oppose to each bill.These designations can change asamendments are added to bills throughout the “becominga bill” process. Each year the Committee hosts RN Day at the Capitol where an education program covering thelegislative process along with regulations affecting RNlicensure is presented. Included is a “meet and greet” timewiththeattendee’sindividuallegislator.Presentlyseventy(70)membersoftheLegislativeCommitteerepresentyou.

In September, ANA\C held the General Assembly whichis the annual business meeting of the Association. At thismeeting proposed bylaw changes occurred along with themembership driven resolution process which guides ANA\Cwith future projects. Dr. Dianne Moore and her teampresented an informative program andmemorable visit withFlorenceNightingale.WewerealltreatedtoashowingofthefilmThe American Nurse.

As you can see so much work is accomplished withdedicated volunteers. Our Association cannot succeedwithout member volunteers and the hard work of yourBoard. The doors that are opening as a result of the ACAaremanyandcomewithadditional responsibilities requiringthe commitment of “a village” to be successful. So again,I am asking you to consider running for an office in yourAssociationorvolunteeringforacommittee.

Andlastly—alittleteaser.YourMembershipCommitteeisbusyplanningfor2015whichisthetwentieth(20)anniversaryofANA\C’sincorporation.Moretoberevealednextyear.

Thank you for your membership and thank you for yourwillingness toget involvedand, thankyoufor theexcellenceyoubringtoourAssociationandprofession.

Untilnexttime

President’s Perspective continued from page 1

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Restrictions apply. See store or sprint.com for details. IL Discount: Available for eligible company or org. employees (ongoing verification). Discounts subject to change according to the company’s agreement with Sprint and are available upon request for monthly data buy-up svc charges for Framily plans. ©2014 Sprint. All rights reserved. Sprint and the logo are trademarks of Sprint. Other marks are the property of their respective owners.

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UCLA Distinguished Alumni Speaker Series 2014

From left to right: Elissa Brown, MSN, RN, PMHCNC-BC - Director of Nursing Practice ANA\C; Courtney H. Lyder, N.D., G.N.P., F.A.A.N. - Dean and Assistant Director, UCLA Health System; Tricia Hunter,

R.N., M.N. – Executive Director & Legislative Advocate, ANA\C; Monica Weisbrich, BSN, RN - President ANA\C attended the UCLA

Distinguished Alumni Speaker Series 2014

Thursday June 5, 2014, Honorable TriciaHunterMN ’83 gave a presentationon “The Importance of Promoting Nursing Policy through the Legislative and Regulatory Process.”The event tookplace at the JamesWestAlumniCenter onthe UCLA campus as part of the UCLADistinguished Alumni Speaker Series.ThisisanannualeventfeaturingtheexemplaryworkandaccomplishmentsbytheSchool ofNursing’sDistinguishedAlumni and proceeds help in establishing theDistinguishedAlumniScholarship.

FormoreinformationorifyouwouldliketodonatetotheUCLADistinguishedAlumniScholarship,pleasecontact:TeresaValenzuela,Director,at [email protected].

Drew Honored by the American Heart Association

Phoebe Byers on July 03, 2014

TheAmericanHeartAssociationhasjust selected Barbara Drew, RN, PhD,to be a 2014 Distinguished Scientist.Drew,professorofphysiologicalnursingand founder of the ECG MonitoringResearch Lab in the UCSF School ofNursing, will receive the award at theAnnualScientificSessionsof theAHAinChicagoinNovember2014.

Of the six scientists selected thisyear, Drew is the only nurse andthe only woman. In fact, this is thefirst time in the history of AHA thata nurse scientist has been selectedas a Distinguished Scientist. Theaward is recognition of the extensivecontributionsDrewhasmadeinthecareofpatientswithcardiacarrhythmias.

Drew has taught clinicalelectrocardiographytomedicalstudents,residents,andgraduatenursingstudentsfor32years.ShealsofoundedtheECGMonitoringResearchLabin theSchoolof Nursing andmentored numerous graduate students pursuing studies in the field ofelectrocardiology.

The primary goal of Drew’s research is to improve cardiac monitoring techniquesandclinicalpracticesinhospitalandpre-hospitalsettingsformoreaccuratediagnosisofcardiacarrhythmias,myocardialischemia,anddrug-inducedlongQTsyndrome.Drew’sresearch has shaped the development of commercial cardiac monitors, including theintroductionofmulti-leadECGmonitoring,ST-segmentandQTintervalmonitoring,andstrategiestoreduceclinicalalarmfatigue.

Barbara Drew, RN, PhD, recently presented her research on expanding

information obtained from ECG recordings to improve clinical

decision-making and patient outcomes in clinical settings at UCSF Alumni

Weekend 2014. Photo by Carmen Holt

In the News

Membership

Donna Dolinar RN BSN MPAANA\C Treasurer

Taking the lead from ANA Membership Assembly and many other organizationsANA\C ismoving toward a paperless event. This year at ANA\CGeneral Assembly onSeptember 6th at Pasadena City College we reduced paper use by posting documentson thewebsite.Thisallowedmembers toview theBookofReports,bylawchanges,andproposedresolutionstobediscussedatGeneralAssembly.

Those that attended theeventprinted thedocuments (hopefullyon recycledpaper)orbrought their electronic device to themeeting to view them there.Wireless internet and

JOIN ANA\C MEMBERS IN CELEBRATING 20 YEARS AS THE PROFESSIONAL NURSING ORGANIZATION IN CALIFORNIA, ADVOCATING

FOR NURSES AND THEIR PATIENTS!

OCTOBER 2015 – OCTOBER 2016

Annual Membership Meeting ~ Save the DateOctober 10, 2015 ~ Northern California

The annual membership meeting is: an opportunity for individuals to promote issues through the resolution process; to nominate a

special colleague for a nursing award; an opportunity for continuing education on current issues; a chance to propose and vote on bylaws

and a chance to meet with other nursing leaders in California!www.anacalifornia.org

General Assembly Goes Greenadditionalelectronicoutletsfortheattendeeswereprovidedbythecollege.Thedocumentsbeingreviewedwerealsoprojectedonascreensothatmemberscouldfollowalong.

Traditionally,allofthedocumentswereprintedforeachattendeeandplacedinafolder.Thiswasvery time consuming aswell as exceptionally costly to theAssociation and theenvironment.Only10bookletswereprinted thisyear.Thesebookletswere for those thatregisteredthedayoftheeventand/ordidn’thaveanelectronicdevice.

Allinallwemadesomepositivestrides.WehopetodoevenbetteratournextGeneralAssemblyin2015.Wewanttobemoreenvironmentallyconscientiousbyworkingwiththevenueandfoodvendorstoreduceenergyconsumptionandusenon-disposableitemsaswellasencourageANA\CMemberstocarpoolortakepublictransportationwhenpossible.

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nursingALD.com


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SherwinWongAnnBilsonMaricrisEberoBrigetteLaoElizabethRadsliffNelsonJoanneBarnettMichaelAcostaAnnHarrisVeronicaZhouEijiYamashitaIgorLivshitsSusanEngleAshleyWatsonKimberlyAdamsJoanneMorrisonDonnaEvansLoisCrossDerekHenssMichelleGoodsLeahRiegelMariaLuisaUsiCristinaCroweJeromeDayaoSondraLeeMargueriteMcMillianOwensLeighOvertonMandiPattersonAnneHeisingerBoazAssiDeniseDerksenBobbiJoRogersMargieChilinMaryHarmonKristinaNixonRodericoDacquelJaniceMcDowellDeliaTagayunaSherondaJohnsonHollySeversonMarqueettaBookerJuanitaMunozDeniseFinchTristanBritaniaLornalynTablanVictoriaHuynhKatherineMirabitoEileenZanardiTracyEverittSharonSandersJoyceAnnElizesLetrinaAlimDianaLeoneShirinGraberCatherinePolkSendyJerezMariaMiyashiroHeidiKaiserAgneseZolaJamesRiddelJrMarivicCuencaZealouieHeyDeGuzmanRicardaCanga

DanaMattMercedesHaklRichelBuenaflorDaleBeattyKatiaMernickMarthaGigglemanKarenMcHoseMichelleOtaniPatrickaGrantMeyerThuyDangMarliesHebertCynthiaSerranoCherylStromanPatriciaHoranbergJeannieHuckoAnaBorbaMarcAnjeloArizalaSallyHigginsLeilaMaePenasalesBreannaMaurerNancyMcCurryJenniferBackerKarenChurchElizabethZhorneKarlaParraRobertaJansenKathleenSharpTaylorNolandPrincessGaleDeguzmanSheilaZangrilliSophieMurdochDeborahScheuerellHamaniMooreBeverlySweeneyKatherineAlcaydeGwendolynFrancismitchellChristineNardiSophieJacksonSandraThompsonNicholeGerberClaudiaChatmanKatieChoyKarenAnzoraJoselynFloresElizabethEggertShaunteGipsonHoneyMonocilloDorothyBarkerDagenMeredithChinJaimeLalongisipIIStephanieFiguerosPamFerolieElizabethWamboltChristinePriorMistyCahoonRebeccaTemplinJessieDAgostinoRuthBarlowCristyCallejoElaineLeonCrystalLoucelCarolynHuman

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Documents

President’s Perspective · information. Nursing has moved into parish nursing, the neighborhood drug store and into the world of geriatrics. Collegiality between nursing and the