The Alaska Nurse - Vol. 60 No. 1 - February 2010

The Official Publication of the Alaska Nurses Association Circulation 7,400 to every Registered Nurse, Licensed Practical Nurse and Student Nurse in Alaska

Volume 60 • No. 1

February 2010

Nurses Week 2010

Page 3

Revisiting the “Five Wishes Bill” Alaska Health Care Decisions Act passed with AaNA support and dedicated advocates

by Juanita Cassellius, LPN

Last summer a political uproar erupted on the national scene over including Medicare coverage for “Advance Care Planning Consultation” in the Health Care Reform Bill (section 1233 of HR 3200). Opponents called the provision a plan for promoting assisted suicide and death panels. Due to the controversy, support for voluntary end-oflife counseling was removed from the Senate bill.

In Alaska, a similar controversy resulted from the proposed Alaska Health Care Decisions Act (AHCDA also known as the Five Wishes bill) designed to place all statutes under one bill and clarify the end-of-life health care laws. The discussion on different versions of the bill went on for seven years from 1997-2004.

The AHCDA pulls together different legal provisions for end-of-life treatment such as

A beaming Carole Edwards pictured with Governor Murkowski at the 2004 signing of the Alaska Health Care Decisions Act. The end of a seven year journey.

December 2009 University of Alaska Nursing Graduates

Page 13

Essay—Standing Under the Waterfall

Page 6

Revisiting the “Five Wishes Bill” continued on page 5

HOSPICE—The Essence of Nursing

by Nancy Davis RN, MS “You matter because of who you are. You matter to the last moment of your life and we will do all we can, not only to help you die peacefully, but also to live until you die.”

Dame Cicely Saunders

Davis

Dame Cicely Saunders of St. Christopher’s Hospice in London first applied the term “hospice” to specialized care for dying patients in 1967. For centuries before, “hospice” was the idea of offering a place of shelter or rest or hospitality to weary and

sick travelers on a long journey. Hospice nursing is care for patients and their families who are making their own journey toward the end of life.

Hospice is a philosophy of care that accepts death as a final stage of life. The focus of hospice nursing is to enable patients to live out their life with dignity and quality, surrounded by their loved ones, with pain and other symptoms managed, and with comfort and care provided to the whole person and their family. Hospice care provides comprehensive physical, psychosocial, emotional, and spiritual care to terminally ill persons and their families. Hospice is all about the quality of life rather than the length of life, with a family centered approach that involves patients and families making the important decisions about life and death.

Hospice nursing is the essence of nursing— relief of suffering and pain, care and compassion, and trust. The nursing is relationship-based as trust and communication are central to successful care. The Hospice nurse not only cares for the needs of the patient at the end of their life, but also prepares the family or caregivers to be

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confident in their own abilities to care for their loved one. Education and support and advocacy are important aspects of nursing care as family members and the patients themselves may struggle with what lies ahead, how the end of life will be, and how they will respond to the actual death. The strength of the entire team is accessible as each patient’s needs are identified, and the care is designed to best meet those needs.

As a nurse, it becomes a true privilege and honor to care for the entire family, to bring together the necessary services and support they need for a successful end of life journey and to be a part of this intimate personal and family situation.

Palliative care, the more recent area of specialization, is defined by the Last Acts Task Force (1999) as the “comprehensive management of the physical, psychological, social, spiritual, and existential needs of patients, particularly those with incurable, progressive illness. The goal of palliative care is to help them achieve the best possible quality of life through relief of suffering, control of symptoms, and restoration HOSPICE-The Essense of Nursing continued on page 4

Inside This Issue Message from AaNA President . . . . . . . . . . . . . . . 2

Senate Bill No. 12. . . . . . . . . . . . . . . . . . . . . . . . . 11

From the Editor’s Desk . . . . . . . . . . . . . . . . . . . . . 3

Membership Application . . . . . . . . . . . . . . . . . . 12

Nurses Need More Training and Support . . . . . . 4

Alaska Nurse Alert & CE . . . . . . . . . . . . . . . . . . 12

Advance Directives for Health Care . . . . . . . . . . . 7

University of Alaska Nursing Graduates . . . . . . 13

Ethical/Legal Questions in Nursing. . . . . . . . . . . 9

Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Alaska Nurse Practitioner Update . . . . . . . . . . . . 9

Upcoming Events . . . . . . . . . . . . . . . . . . . . . . . . . 14

Safe Nursing & Patient Care Act . . . . . . . . . . . . 10

Letter to the Editor . . . . . . . . . . . . . . . . . . . . . . . . 15

The AaNA Vision Empowering Alaska nurses to be dynamic leaders, powerful in both the health care and political communities.

Page 2 • Alaska Nurse

February 2010

Author Guidelines for the Alaska Nurse The editorial committee welcomes original articles for publication. Preference is given to nursing and health related topics in Alaska.

Authors are not required to be members of the Alaska Nurses Association.

Format and Submission Articles should be Word documents in 10 or 12 point font, single or double spaced.

There is currently no limit on the length of the article. Include the title of the article and headings if applicable. Author’s name should be placed after the title with credentials, organization/and or employer and contact information. Authors must identify potential conflicts of interest, whether of financial or other nature and identify any commercial affiliation if applicable.

All references should be listed at the end of the article. Pictures in black and white or color are encouraged and may be sent

as a jpg. file, as an email attachment or on disc. Photographs sent to the Alaska Nurse will become property of the AaNA. We hope that we will be sent copies, not originals and prefer emailed files. Photos should be provided with a caption and photo credit info and be high resolution. Be sure to spell check, grammar check and second check the article, any website addresses, references or phone numbers. It is recommended you have a colleague review your article before submission.

Prepare the article as a WORD document and attach it to an email to editor@aknurse. org. If you do not have WORD, try pasting the text of the article directly into the body of the email. You may also mail the article on disc to Editor, AK Nurse, Alaska Nurses Association, 3701 East Tudor Road Ste 208, Anchorage, AK 99507. If you have any questions email the Editor, Lynn Hartz at lhartz@alaska.com.

Message from AaNA President Happy 2010 from the Alaska Nurses Association…

by Nancy Davis RN, MS AaNA President It certainly started with fireworks. After a surprising vote in the US Senate on the Health Care Reform bill, there was a lot of energy and noise on both sides of the aisle and the issue.

Regardless of what your politics are, the dialogue about health care and health insurance reform is interesting and frustrating, spirited and dull, brilliant and stupid. It just depends on which way your politics lean. It is either the worst thing that will happen to the US economy or the true salvation of the US economy. It seems that there is very little grey area or lukewarm sentiment about the health care reform positions.

I can’t help but believe that the truth lies somewhere between the two extremes. So I want to focus on some important improvements for nursing within the health reform bills. Both the House and Senate versions contain many important opportunities for nursing and nurses.

We are patient advocates; we stand up for the patient’s rights and for those without a voice.

We recognize that nursing professionals make significant contributions to the health of our nation and to the health care system, and that nurses should be active participants not only in the delivery of health care but also the design of our system.

On January 6, 2010, The Nursing Community, a collective effort of forty-three nursing organizations, sent a letter to Speaker Nancy Pelosi and to Senate Majority leader Harry Reid, outlining specific requests for support of provisions in the House’s Affordable Health Care for America Act of 2009 (H.R. 3962) and the Senate’s Patient Protection and Affordable Care Act (H.R. 3590).

The letter also highlights the provisions that need modification to earn the Nursing Community’s support.

Some of the provisions supported by The Nursing Community will enhance nursing education, promote workforce diversity in nursing, invest in graduate nursing education to prepare advanced practice nurses and nursing faculty, provide scholarships and loan repayment support

for basic and advanced education in nursing, support more nurse managed health clinics, support nurses in primary care, prevention and public health, improve equity in payments to primary care providers and certified nurse midwives, increase support for community care options and care coordination services, provide for more school based health services, promote best practices in health care delivery, encourage more research and attention to pain management interventions, and provide more protections for quality care in nursing homes.

The Nursing Community letter cited areas needing modification that include expanding the sites for Medicare Graduate Nurse Education demonstration projects (currently planned for only five hospitals in the nation); having Advanced Practice RNs be full participants in the incentive programs for performance based care; assuring nursing participation in a National Health Care Workforce Commission; and including nursesensitive quality and performance measures as critical data components in comparative effectiveness research efforts.

All of these issues of specific concern to our profession are included in the massive health care reform bills in some fashion. Our national nursing organizations, and notably the American Nurses Association, have been active voices in the health reform effort. We as nurses in Alaska need to take opportunities to advise our delegation of our interests as nurses. So no matter what you as an individual think of the current health reform bills, it is important to recognize this unique opportunity for nurses to influence our nation’s next steps in improving health care for all our citizens. Your voice is important and such effort is definitely a part of our professional commitment to health care for all.

As I write this nothing is certain: whether a final bill will pass, or if it does what it will contain. I am hopeful that great decisions and great courage will bring the necessary improvements in our health care system and that we as nurses will know that we are a part of that improvement.

Here’s to a great 2010 ahead.

An official publication of the Alaska Nurses Association, 3701 East Tudor Rd., Ste. 208, Anchorage, AK 99507. Tel: 907/274-0827. Web site: www.aknurse.org. Published quarterly.

Materials may not be reproduced permission from the Editor.

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Editor: Lynn E. Hartz, MSN, FNP lhartz@alaska.com AaNA Board of Directors President: Nancy C. Davis, RN, MS Vice President: Paul T. Mordini, RN-C, BSN, MS Secretary: Diana Robinson, RN, CDS Treasurer: Donna Phillips, RN, BSN Directors: Labor Council (designee): Susan Walsh, RN Rural Director: Pam Embler, MSN, RN Greater Alaska Director: Shelley Burlison, RN Staff Nurse Director: Kathleen A. Gettys, RN, BSN, BA Directors at Large: Donna Biagioni, RN, BSN Joe Peacott, RN Carol Widman, RN, BA, BSN Michelle L. Marshall, MSN, RN AaNA Labor Council Chair—Donna Phillips, RN, BSN Vice-Chair— Secretary— Treasurer—Megan Orien, RN Directors: Paul Bryner, RN Carol Clausson, RN, C Kathleen A. Gettys, RN, BSN, BA Diana Robinson, RN, CDS Mary Stackhouse, RNC, CLNC PAMC BU Rep.—Joe Peacott, RN Soldotna BU Rep.—Velinda Albrechta-East, RN Ketchikan BU Rep.—Susan Walsh, RN Affiliate Organizations: Alaska Chapter of the American College of Nurse Midwives Alaska Home Health and Hospice Association Alaska Nurse Anesthetists Association Alaska Nurse Practitioner Association Alaska School Nurses Association Forensic Nurses Association, Alaska Chapter Executive Director: Debbie Thompson, BSN, RN, CNOR For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, sales@aldpub.com. AaNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.

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

February 2010

Alaska Nurse • Page 3

Nurses Week 2010

From the Editor’s Desk The Five Wishes Bill and Why all these articles on Hospice etc.?

Lynn Hartz, Editor In 2007 an email was forwarded to me from a student nurse out of state asking about Alaska’s “Five Wishes Bill.” What was the history? What was it about and how did it come to pass?

Personally, I had not been involved with the issue and through the internet and checking records did not find much either.

I only knew that the Hartz AaNA and a nurse, Carole Edwards, had been involved, and it had taken awhile. I was not able to give the student any good answers. At the time there was not any National

Healthcare Decisions Day with it’s website and multiple links (see page 4, 9). In this issue not only are those student’s questions finally answered (long after her report was due I’m sure): other important end-of-life topics are considered.

Tackling end-of-life issues in a Spring nursing newsletter took on it’s own momentum as Gary Goins sent in an essay on organ donation and Nancy Davis volunteered to write on Hospice.

Though it can be a difficult subject, it is one that is universal for nursing and for us all as human beings. I hope those of you with expertise in the area will feel free to contribute more information if you feel that it is needed; and for those of you who have not approached this subject in awhile, there is good news out there. I hope you will find the information in this issue useful.

Special thanks go to Juanita Cassellius for answering the call “would somebody please do a retrospective on the Five Wishes Bill?”

March of Dimes Nurse of the Year Awards

by Janie Odgers, State Director March of Dimes, Alaska Chapter The 2009 March of Dimes Nurse of the Year Awards were presented November 20 at the Sheraton, Anchorage. The yearly awards ceremony honors nurses from around Alaska who have made a significant impact on their community and the profession of nursing. The March of Dimes Nurse of the Year program recognizes RNs or LPNs in 18 categories. Patients, friends, colleagues and other health professionals may nominate nurses for the awards. The 2009 awardees are listed below.

1. “Advanced Practice” Hilma Lewis, Fairbanks Memorial Denali Center 2. “Ambulatory Nursing” Tamara Collins, Bartlett Regional Hospital 3. “Behavioral Health” Annabel Moreno Providence Alaska Medical Center 4. “Case Management Care Coordinator” Amy Jenkins, Mat-Su Regional Medical Center 5. “Child Advocacy” Mary Stockwell-White Fairbanks Memorial Hospital 6. “Community/Public Health/Rural/School” Paula Ciniero Fairbanks Memorial Hospital 7. “Critical Care, Adults” Betsy Kauffman-Harmon Mat-Su Regional Medical Center 8. “Education/Research” Jill Montague, Alaska Native Medical Center 9. “Emergency/Flight” Karen Galluccio-Mott Alaska Regional Hospital 10. “Friend of Nursing” Cathy Baldwin-Johnson Providence Alaska Medical Center

11. “General Medical/Surgical” Janet Hagensicker Providence Alaska Medical Center 12. “Maternal/Newborn” Dina Banez, Providence Alaska Medical Center 13. “NICU” Claudia Starr Providence Alaska Medical Center 14. “Nursing Administration/Management” Julie Palm Alaska Native Medical Center 15. “Pediatrics” Tracey Gosser, 3rd Medical Group 16. “Preoperative” Tim Gillispie, 3rd Medical Group 17. “Rehabilitation” Ellen Lechtenberger, Alaska Regional Hospital 18. “Rising Star” Ami Reifenstein, Bartlett Regional Hospital Legend in Nursing Winners 1. Marguerite Armstrong Providence Alaska Medical Center 2. Judy Cernobyl, Bartlett Regional Hospital 3. Judy Glasspool, Ketchikan General Hospital 4. Janice Gray, State of Alaska, Juneau 5. Debra Manowski, Bartlett Regional Hospital 6. Juanita McDermott Providence Alaska Medical Center 7. Bernadette Modelo Samuel Simmonds Memorial Hospital, Barrow 8. Justine Muench, Bartlett Regional Hospital 9. Gretchen Saupe, Legend, Retired, Kodiak 10. Cynthia Yocum, Fairbanks Memorial Hospital Jodgers@marchofdimes.com Contact Ms. Odgers for nomination forms for the 2010 Nurse of the Year.

For more information on the Alaska March of Dimes see: marchofdimes.com/alaska

Nurses: Caring Today for a Healthier Tomorrow National Nurses Week begins each year on May 6th and ends on May 12th, Florence Nightingale’s birthday.

As of 1998, May 8 was designated as National Student Nurses Day, to be celebrated annually.

And as of 2003, National School Nurse Day is celebrated on the Wednesday within National Nurses Week (May 6-12) each year. The nursing profession has been supported and promoted by the American Nurses Association (ANA) since 1897. Each of ANA’s state and territorial nurses associations promotes the nursing profession at the state and regional levels. Each conducts celebrations on these dates to recognize the contributions that nurses and nursing make to the community.

[Editors Note: Once again: my annual apology to the readership for an article on this event two months early, but with only a quarterly edition, this is as close as we can get. Be sure to check out the AaNA website aknurse.org for up to date information on Nurses Week events. Featured on this page is a coupon special generously donated by the Great Harvest Bread Co. in Anchorage in honor of Nurses Week. If you make use of it, please give them a big Thank You.]

Page 4 • Alaska Nurse

Nurses Need More Training and Support For End-ofLife Discussions

by Juanita Casselius LPN The Patient Self-Determination Act passed by Congress in 1991, requires healthcare facilities receiving Medicare and Medicaid funding to provide patients with education about advance directives. The State of Alaska also has licensure regulations requiring hospitals, nursing homes, home health agencies, and hospices to inform patients about advance directives.

Current culture often dictates that the responsibility for discussion of advance directives falls on the physician. In reality, the majority of patient contacts occur with the bedside nurse.

Researchers agree that the role of the nurse includes patient advocacy to ensure that patients are informed about their rights to complete advance directives.

Putman-Casdorph et al. found that nurses identify the benefits of advance directives, and have positive attitudes but lack knowledge and confidence to effectively discuss end-of-life issues with patients and families.

One of the problems found with achieving the original intent of the Patient Self determination Act is the perception that once the documents are completed, planning is considered finished.

This results in failures of follow-up with patient education, providing the hospital with a copy of the directive, and discussing the advance directive with their physician.(1) Providence Alaska Medical Center Ethicist, Maria Wallington, M.D., provided testimony and education for the Alaska Health Care Decisions Act in 2004.

She commented that, “the potential of advance directives hasn’t proved itself.”

In Alaska, according to the Advance Directive Proclamation by Governor Palin (4/2008), “an estimated 20% of people in Alaska and 50% of severely or terminally ill patients have advance directives.”

“End of life counseling should be paid for,” according to Dr. Wallington. “There’s a need for well-informed decision makers. It’s a very long conversation to know where the patient is and give them information to navigate the complex medical questions involved.”

According to a study conducted in four states to measure knowledge, attitudes, and experiences of oncology nurses in end-of-life care, environments need to change to provide more autonomy and support to nurses to facilitate an atmosphere that promotes a team approach to end-of-life care.(1) Reference 1. Putman-Casdorph H, PhD, RN; Drenning C, MSN, CRNP; Richards S, BSN, RN; Messenger K, BSN, RN, BC. Advance Directives—Evaluation of nurses’ knowledge, attitude, confidence and experience. Journal of Nursing Care Quality. 2009; Vol. 24, No. 3 pp 257-262.

[Juanita Cassellius, LPN, works in Health and Social Services with the State of Alaska and has a B.A. in journalism.]

February 2010 HOSPICE-The Essense of Nursing continued from page 1 of functional capacity, while remaining sensitive to personal, cultural and religious values, beliefs and practices.”

There is a distinct body of knowledge with direct application to the practice of hospice and palliative care nursing. This includes: pain and symptom management; end-stage disease processes; psychosocial, spiritual, and culturally sensitive care of patients and their families; interdisciplinary collaborative practice; loss and grief issues; patient education and advocacy; bereavement care; ethical and legal considerations; communication skills; and awareness of community resources. Both the hospice and palliative care nurse have a similar knowledge base. Certification for nurses practicing in hospice and palliative care as a Certified Hospice and Palliative Nurse (CHPN) has been available since 1999, following the initial development of the Certified Nurse Hospice (CRNH) in 1994. The certification process reflects a competency basis for the evaluation of an individual’s practice and is not an advanced practice certification. {Source: Hospice and Palliative Nurses Association (HPNA)} I am new to hospice nursing, having begun as a Hospice and Home Health nurse after a long career primarily in public health nursing. I find the nurses I work with to be extraordinary in their care and compassion, and their ability to bring their therapeutic self to each patient and family in such a way that honors who that patient is and what is important for them. The nurses demonstrate exceptional ability to communicate with the doctors and the rest of the Hospice team of home health aides, therapists, social workers, volunteers, pharmacies, and equipment suppliers to assure that the patient is wonderfully served and appropriately provided all they need to control pain and assure comfort. I see them cope with their frustrations when pain control is elusive, and when family crises arise that impact the patient’s comfort. They not only manage the patient’s situation but they must also balance the normal events in their own lives which deserve attention and energy—and yet they rise to the needs of the patients without fail.

Families sometimes send notes of thanks to the nurses and the other team members following the death of their loved one. They say the nurses were

like “angels” and say they could not have made it without the help of the nurses. The nurses attend the memorial services for patients they have cared for, and follow up with bereavement visits or contacts with family members.

Sometimes friends and family ask “How can you do hospice work?”, perceiving it to be a sad assignment, filled with losses and deaths.

Curiously enough, it is sad to lose people, to have their lives end so that we no longer can enjoy their company, but it is a finer peace that comes with knowing you have provided care and comfort to patients and families, at a time when it is most needed, and have helped someone make their final journey according to their own wishes.

It is probably the notion that hospice is sad or depressing that causes some patients, families, and even doctors to delay referring a patient for hospice care. Denial of the incurable nature of an illness, or that treatment options are exhausted also contribute to delays in seeking hospice services.

However, hospice care is really about hope when all other options are exhausted. Hospice care can provide hope for quality and comfort, and making the best of each day during the last stages of advanced or incurable illness. My experience working with hospice nursing has forever changed my notions about end of life care.

I hope there will always be hospice care available for those patients and families who choose it. It is definitely in my plan for end of life care when that time comes. I encourage all nurses to become familiar with the options for hospice services for their patients and for their own families. If you are thinking of hospice nursing as a type of work you might consider, contact your local hospice nursing service for more information. (see below) Author’s note: Hospice services are covered under the Medicare Hospice benefit (the Medicare Benefit Act of 1983), and some insurance companies will authorize palliative care or hospice services as a benefit exemption even when hospice is not listed as a benefit under the plan.

Medicaid and Veterans Administration may also authorize palliative care or hospice services for their beneficiaries.

[Nancy Davis, RN, MS is currently the Program Director for Hospice and Home Care of Juneau, a Division of Catholic Community Services.]

RESOURCES on Advance Directives/Hospice/Healthcare Decisions Day National Healthcare Decisions Day April 16—www.nationalhealthcaredecisionsday.org Hospice of Anchorage—www.hospiceofanchorage.org Hospice of Homer—www.hospiceofhomer.org Hospice of Tanana Valley—www.hospicetv.org National Hospice Foundation—www.caringinfo.org U.S. Living Will Registry—www.uslivingwillregistry.org Provides 24/7 online access to living wills.

A fee is charged.

Med-Line Plus (www.nlm.nih.gov/medlineplus/advancedirectives.html) and AARP have alot of info, research under Advance Directives. More languages available.

Jane Brody’s Guide to the Great Beyond: A practical primer to help you and your loved ones prepare medically, legally and emotionally for the end of life.

Jane E. Brody, Health columnist for the NY times. Random House, 2009.

End-of-Life Nursing Education Consortium—online training http://www.aacn.nche.edu/ELNEC/ [Editor’s note—this list does not presume to be complete and websites given may have links to other websites.]

February 2010

Alaska Nurse • Page 5

New ANP Pediatric Behavioral Clinic in Anchorage Little did Cynthia Ebelacker know when she accepted her first Air Force duty tour to Fairbanks in 1985 that Alaska would get under her skin, or that she would eventually be reassigned to Elmendorf Air Force Base in 1994, then retire and plant her roots in the Anchorage area.

After having spent over twenty years managing the healthcare of children in various settings as a pediatric nurse practitioner (PNP), Cynthia was more than ready to set up her own pediatric practice, and to have more time to spend with each patient. Her experience as Assistant Director of the large pediatric clinic at Elmendorf helped her with management of the clinic day-to-day operations as well.

She opened Alaska Women’s and Children’s Clinic in Eagle River in August 1998, working in a shared space with a Women’s Health Nurse Practitioner. In 2000 she moved and expanded her own clinic, the Alaska Family Healthcare Clinicalso in Eagle River. At one point she employed an ANP, a Women’s Health NP and 3 CMA/ office staff.

Cynthia took care of many of the town’s neediest clients. She began to see a trend in the

increased emotional problems she was finding in these impoverished children. At that time, many of the new adult psychotherapy meds were just beginning to be used to treat children with mental illness diagnoses. Her training to that point had not really prepared her to treat these children and it was often frustrating to find them referrals to a pediatric psychiatrist, let alone one that would take Medicaid clients.

About that time Cynthia was also starting to feel that her clinic was starting to own her. It was a lot of work to run a large practice. The Air Force had given her an appetite for challenging experiences so she thought she might just take a UAA class on psychotherapy medications, but when she went to register, she ended up taking the 2-year Family Psychiatric Mental Health Nurse Practitioner Program that was beginning in 2006. Luckily, she was able to sell her clinic to a local physician.

While in the program Cynthia wanted more pediatric-specific psychiatric experience. She worked at North Star Residential facilities for two years both as a staff RN in the children and adolescent girls unit and as a PNP performing admission physicals for residential patients. She

Revisiting the “Five Wishes Bill” continued from page 1

politics, but got involved with issues because they are personal to her, and her input made a difference. Since her father-in-law died of prostate cancer, she lobbied the Alaska Legislature for a bill to provide prostate cancer screening insurance coverage for men over 50. That bill was the only minority bill passed that session in 1997. Later, her husband benefited from that screening, as he was diagnosed in the early stage of prostate cancer and treated successfully.

After retiring from Bartlett Regional Hospital after a 20 year career in oncology, Edwards continues working in health policy as a board member for the Oncology Nursing Society (ONS) on the state and national level. In 2009, she was awarded the ONS Excellence in Oncology Nursing Health Policy and Advocacy Award, and received the Cancer Connection Caregiver Award from the Juneau Cancer Connection organization, and the Edna Woodman Volunteerism Award from Bartlett Regional Hospital.

It’s clear from her work that one nurse can make a significant contribution to health policy.

Especially in Alaska with its small population, she says, “It’s different politically than the more populated states. Advocacy is much easier. Often times your representatives are your neighbors.

They’re so much more accessible.”

In our huge state the teleconference technology makes it possible to get involved whether you live in Barrow or Anchorage and can’t take time off to fly to the State capitol to have your voice heard.

And there’s an advantage to that, according to Edwards, because “it’s a lot less nerve wracking to make a call” than appearing in front of a committee.

The Alaska Health Care Decisions Act is on the record now, “but it’s worthless if people aren’t aware of it and don’t put their decisions in writing,” according to Edwards. Nurses at the bedside are in a position to assist patients with making their plans for end of life, as well as educating the community.

She worked with “way too many families who don’t know what their parents want, or disagree on what to do. The living will isn’t just for patients.

It’s for families and caregivers, too. It’s is a loving gift to give your family so that in a time of crisis they know what you want.”

Edwards is so “fanatical” about her living will that she carries it with her in a carry-on for all her travel.

advance health care directives, mental health treatment, CPR orders, organ donation and durable power of attorney laws into one location in state statutes.

These end-of-life directives are documents written by competent persons to communicate their preferences for life-sustaining treatment and agents in the event they are incapable of speaking for themselves.

The efforts to educate the legislators by then Alaska Nurses Association Board Member Carole Edwards, RN, BSN, John Bitney, AaNA lobbyist, and others such as Providence Alaska Medical Center Ethicist, Maria Wallington, M.D. resulted in changed attitudes.

“Sen. Fred Dyson was strongly opposed to it,” Edwards said. “He became one of our strongest allies and testified for the bill.”

Lobbyist, John Bitney commented about Carole Edward’s work on the bill, “It’s hard to put into words the impact Carole had. Her presence and strong voice were highly respected and regarded by the legislators on all sides. You have to put yourself in the shoes of the legislators…they were clearly stressed to face voting on a bill that dealt with the topic of death. Hearings on the details of the bill could sometimes be very sobering and emotional.” Bitney now serves as Chief of Staff for Representative John Harris of Valdez.

The AHCDA passed unanimously in 2004.

The law provides a model form and gives the option of writing directives without using the form as long as legal guidelines are met.

“It was a struggle,” said Carole describing the process of working on the bill. Opposing comments included, “You’re trying to play God” by removing life support. Edwards responded, “Before all the technology existed 100 years ago, people would die naturally without these interventions. It was a non-issue then.”

Many legislators didn’t understand the natural death process, according to Edwards. “My role was educating about the end of life. My testimony was almost all stories about patients. People remember personal stories more than statistics and numbers alone. The legislators didn’t understand that pain medication for the dying isn’t assisted suicide.

They felt that the dying would suffer more if IV nutrition and fluid were withheld, “she said.

When asked if she was ever discouraged and considered giving up on the legislation, she said, “No. When I was frustrated and angry with someone, I was more determined.” Her husband of 48 years, Lou, was always an encouragement.

“He told me I could do things that I didn’t think I could do,” she said. AaNA Lobbyist John Bitney also provided support with expertise on the legislative process, and was by her side through all the committee hearings.

Edwards said she was never interested in

[Juanita Cassellius, LPN, works in Health and Social Services with the State of Alaska and has a B.A. in journalism.]

[Editor’s note—For the benefit of our readers, the form for Advance Directives for Health Care & Mental Health Care contained in the AHCDA is reprinted in its entirety on page 7-8.]

also did a preceptorship in a private psychiatric practice seeing children and adults. After she graduated in May 2008 she worked for a year at Good Samaritan Counseling Center with children ages 3-18, doing psychiatric evaluations and medication management.

Eventually, Ebelacker was able to fully utilize her two specialties of pediatric and psychiatric advanced practice nursing in a setting where she could evaluate the total child in order to more accurately diagnose and treat childhood mental illnesses. In May of 2009, Cynthia opened a private solo practice specializing in pediatric behavioral problems in Anchorage. She welcomes questions and referrals from her nursing colleagues.

Referral and Contact Information: Cynthia Ebelacker, ANP, MSN Pediatrics and Behavioral Medicine 1407 W. 31st Ave Anchorage, AK 907-646-9948 cjames@ak.net.

Page 6 • Alaska Nurse

Essay—Standing Under the Waterfall

by Gary Goins RN, MSN

photo by L.Hartz/Kauai

I’ve worked as a Registered Nurse since 1993, mostly in ICU and ER. I have witnessed, like many of us, incidents of people at their worst and at their best. Every once in a while a story would come closer, touch and affect me.

Manya of those stories occurred when a young person was killed in an accident and was a candidate to become an organ donor. I have read, watched and heard stories of tragedy and growth. Here is

mine.

In 1999, I was diagnosed with Ankylosing Spondylitis. HLA-B27 positive uveitis. This inflammation of my eye is a component of that genetic linkage. Since age 24, I have been waging a gentle war on my right eye for iritis, a three to four times per year interruption in my daily life. I was able to control the painful exacerbations with eye drops and patience. The issue was manageable and I had set my sights around the country to find a home-site while working as an R.N. That changed in 2006.

January-November 2006—San Francisco, CA While working in Reno, Nevada the iritis became worse and my physician recommended I see Todd Margolis, M.D. at the Proctor Eye Center of UCSF. The Proctor Eye Institute located in a fog-enshrouded wooden 1960’s building belies its significance in the world of eye health. We tried interventions to protect my eye but in November the ocular pressure was 49 (20 and below is normal). Later that week it was 52. Dr. Margolis set up an urgent evaluation with Dr. Sydney Williams a glaucoma specialist. Dr. Williams office called me to set up a time. I told them I had time off in December. His practice assistant said “please be in San Francisco in the morning.” One day later a trabeculectomy to establish a drain to decrease the pressure in the eye and lens replacement was accomplished. After a couple weeks the vision in my right eye was superior to my left.

November 2008—Anchorage Alaska After two years of problem-free living, I had moved to Anchorage and was working at Providence. Feeling fine, I went for a vision check

and the Optometrist was alarmed. He urged me to see Dr. Morgan and she referred me to a corneal specialist (there is one in Anchorage), Dr. Griff Steiner. After his examination he told me that my right cornea was swollen and that the epithelial cells responsible for extracting fluid from the eye had failed. As weeks went by, the eye became cloudy (again) and my vision worsened.

Like many people with an illness, I could cope.

Not a complainer, I persisted. On my second visit with Dr. Steiner he introduced the concept of a DSAEK corneal transplant. I was aware then that this was a bigger issue than I had previously thought. He told me that there were several advantages to the DSAEK operation compared to standard corneal transplant surgery. I was referred to Dr. David Hwang of UCSF. I called and set an appointment and we met in August. DSAEK was scheduled for September 30.

I am not sure at what point I realized that a cornea would have to be found for me and donated.

It meant someone was going to die and that part of their eye would be transplanted to me. When it did come to mind, I dismissed it quickly. Over the next few weeks I recognized that my feelings were complex and most of them uncomfortable. After two weeks I could not dismiss my feelings or deny them. They were pressing. I felt dull and a little fearful. I felt awful, knowing that someone was going to die. I felt awkward with this knowledge and these feelings and felt out of my depth. I found myself feeling duller and sad. This was new. This sadness began to assert itself and slight feelings of guilt were present, and though I knew these feelings were inappropriate to be sure, they were present.

Like many of us I had seen the “process” with a patient who was going to become a donor, the teams coming in and out, the family’s decision making process and the deeply moving relationship between them and the donor nurses. In addition, I knew the intensive nursing process required for days and nights to keep the donor viable leading to the rush when nurses, surgeons and air transport were all in place. Being aware of this, working with the teams and seeing it firsthand at the bedside had not prepared me. I wish I could say it had but at work there are built in boundaries. This new experience was personal and prescient.

I made a conscious decision to begin talking about my feelings to anyone who would listen carefully. So I did. To my adult children Alfie and Ayrielle whose responses were measured and simple in words and support. Knowing they were aware of this event in my life made it much easier emotionally. Colleagues were curious but in an ICU it is busy and not much time for ‘chitty chat.’

Besides critical care nurses like me are strong, ready for everything, and yes as a man it can be hard to put words with feelings and come to terms with the vulnerability. My colleagues’ gentle awareness helped; I do think that it did.

The talking began to help in small ways and allowed me to get my feelings “out there.” It began to provide a structure for what was a brand-new experience. Then came a lucky conversation. Over the main ICU counter, one day, I was talking with Mark, the manager of the inpatient dialysis unit and I revealed how I was feeling. He stopped, looked right at me and said, “Gary, it’s the most beautiful gift.” From that moment I started to comprehend and learn without the anxiety and the fear, reaching for his words, which I had yet to fully understand.

August 2009—San Francisco I met with Dr. Hwang and his staff. As a part of his interview with me, he explained that unfortunately someone tragically loses their life.

That was a painful moment for me but a necessary one. He told me that following the procedure I could, should I wish to, send a thank-you letter to the donor family anonymously. He said that nationwide this only happens 7% of the time. In his practice it happens about 40% of the time.

Donna, Dr. Hwang’s PA, explained that there was a 5% chance that a suitable donor would not be found and that if so my flight to San Francisco would be up in the air. If the surgery went forward the instructions were to take 10 to 14 days off work.

Due to the lifting restrictions, I would have to be off work for one month.

After the pre op meeting, I steeled myself from the reality that a person was going to die and focused on the opportunity that I potentially would

February 2010

be able to see again from my now very cloudy right eye. I started to sleep a little better and not be so pensive about it. Things improved emotionally as I got support and kept talking about it.

September 29, 2009—San Francisco Donna called and let me know that they had received a donor cornea. That instant there was a quiet “thank you” inside of me; reality set in. On the 30th, Dr. Hwang and his nurse explained that they were going to prepare the cornea. Surgery was brief, and I had to be partially awake, which was unpleasant (and the good news is that Versed works).

After surgery I had to keep my head perfectly still. To reinforce this, the team placed a C collar and a brace on either side of my head similar to trauma head restraint and taped the whole contraption to the bed on either side. There is a reason for this. Dr. Hwang explained that he placed a gas bubble behind the graft to hold the graft in place. In addition, he placed an additional gas bubble to prevent the preexisting drain in my eye from functioning. And, there I was looking at the ceiling . . . for six hours.

The R.N. in PACU was superb. Caring. Focused, attentive and owned a holster armed with Fentanyl, Zofran and ice chips. She was there for all six hours. Bright, responsive and caring, she explained to me that she only recovers eye surgeries, Remarkable.

When I woke up the next day, as I stood up with help, the feelings of gratitude were immediately in my mind and when I focused on them they became global and distinct. A feeling of luckiness and warmth came over me. I felt connected to people in a very intimate way, that this person who had lost their life and their family and I were aware of one another without knowing one another. The wave of pure gratitude surprised me and affected me deeply. My son once said “Gratitude is tears falling into mountain snow.”

Initially, I had no words, it was all inside. I stayed in San Francisco for an additional three weeks and each day I woke up the feeling was present. Diane, my true friend, a critical care R.N. herself watched over me and we followed the doctor’s instructions strictly since it seemed not following his instructions to the letter would be a slap to the gift which I received. We were serious about it. It became our only job.

I saw Dr. Hwang the day after surgery.

“Marvelous” he said. The graft had attached. One week later the result was unchanged and at two weeks it was perfect. I waited an additional week and then flew home.

As the gas bubble dissolved, my vision started to return. I could see my hand, the hallway and when I saw the letters in Marriott I was so excited. The cloudiness was gone. I was healing. It began many small discoveries, each with small grateful tears, each with a new feeling inside me that the donor family was in my thoughts. I felt so connected to them and to every person, more than ever before.

This was a brand-new road.

December, 2009—Anchorage Today, I can see 100% of what I could not see before. Each day I can see more, and if pressed, I could navigate using only my right eye. At my last visit November 17 in San Francisco when they put a “pinhole” device on my eye, I could read large letters. Each day a little more detail arrives.

Patience is a virtue and doctor says it can be. Dr. Hwang predicts 24/20 and that sounds just great to me.

This experience was a journey. As Bob Ballard said about his profound emotional reaction to discovering the Titanic, “It was an experience I did not expect to have.”

The interconnections and my gratitude are more real and deeper. The web of life which sent me on this journey, and this “beautiful gift” is simple and means a lot to so many people. I wrote the donor family a note two weeks ago to thank them. It was not hard to put my feelings into words.

I feel I am standing below a crystal clear and cold waterfall and it is cascading on my face and eyes as I reach up to embrace the sunlight.

[Gary Goins RN, currently works at Alaska Regional Hospital in the critical care unit.]

February 2010

Alaska Nurse • Page 7

Advance Directives for Health Care & Mental Health Care The Advance Directives for Health Care & Mental Health Care document that follows is the form that is in the Alaska Health Care Decisions Act. It is printed in its entirety for those of you who may not be familiar with it. The form is available from the Legislative Information Office in Anchorage and upon the printing of this edition of the Alaska Nurse, it will be available online at aknurse.org; click Alaska Nurse archives. In honor of National Healthcare Decisions Day coming up, and of all the work that went into getting this form into statute, making the form available to every nurse in the state seemed like a good idea. For more information see Resources on Advance Healthcare Directives on page 4 and National Healthcare Decisions Day on page 9.

In this advance health care directive, “competent” means that you have the capacity (1) to assimilate relevant facts and to appreciate and understand your situation with regard to those facts; and (2) to participate in treatment decisions by means of a rational thought process.

following box, my agent’s authority becomes effective when a court determines I am unable to make my own decisions, or, in an emergency, if my primary physician or another health care provider determines I am unable to make my own decisions.

If I mark this box [ ], my agent’s authority to make health care decisions for me takes effect immediately.

The form that follows is found in AS 13.52.300

EXPLANATION You have the right to give instructions about your own health care to the extent allowed by law. You also have the right to name someone else to make health care decisions for you to the extent allowed by law. This form lets you do either or both of these things. It also lets you express your wishes regarding the designation of your health care provider. If you use this form, you may complete or modify all or any part of it. You are free to use a different form if the form complies with the requirements of AS 13.52.

Part 1 of this form is a durable power of attorney for health care. A “durable power attorney for health care” means the designation of an agent to make health care decisions for you. Part 1 lets you name another individual as an agent to make health care decisions for you if you do not have the capacity to make your own decisions or if you want someone else to make those decisions for you now even though you still have the capacity to make those decisions. You may name an alternate agent to act for you if your first choice is not willing, able, or reasonably available to make decisions for you. Unless related to you, your agent may not be an owner, operator, or employee of a health care institution where you are receiving care.

Unless the form you sign limits the authority of your agent, your agent may make all health care decisions for you that you could legally make for yourself. This form has a place for you to limit the authority of your agent.

You do not have to limit the authority of your agent if you wish to rely on your agent for all health care decisions that may have to be made.

If you choose not to limit the authority of your agent, your agent will have the right, to the extent allowed by law, to (a) consent or refuse consent to any care, treatment, service, or procedure to maintain, diagnose, or otherwise affect a physical or mental condition, including the administration or discontinuation of psychotropic medication; (b) select or discharge health care providers and institutions; (c) approve or disapprove proposed diagnostic tests, surgical procedures, and programs of medication; and (d) direct the provision, withholding, or withdrawal of artificial nutrition and hydration and all other forms of health care; and (e) make an anatomical gift following your death.

(1) DESIGNATION OF AGENT.

(4) AGENT’S OBLIGATION. My agent shall make health care decisions for me in accordance with this durable power of attorney for health care, any instructions I give in Part 2 of this form, and my other wishes to the extent known to my agent. To the extent my wishes are unknown, my agent shall make health care decisions for me in accordance with what my agent determines to be in my best interest.

In determining my best interest, my agent shall consider my personal values to the extent known to my agent.

Part 2 of this form lets you give specific instructions for any aspect of your health care to the extent allowed by law, except you may not authorize mercy killing, assisted suicide, or euthanasia.

Choices are provided for you to express your wishes regarding the provision, withholding, or withdrawal of treatment to keep you alive, including the provision of artificial nutrition and hydration, as well as the provision of pain relief medication. Space is provided for you to add to the choices you have made or for you to write out any additional wishes.

Part 3 of this form lets you express an intention to make an anatomical gift following your death.

Part 4 of this form lets you make decisions in advance about certain types of mental health treatment.

Part 5 of this form lets you designate a physician to have primary responsibility for your health care.

After completing this form, sign and date the form at the end and have the form witnessed by one of the two alternative methods listed below. Give a copy of the signed and completed form to your physician, to any other health care providers you may have, to any health care institution at which you are receiving care, and to any health care agents you have named. You should talk to the person you have named as your agent to make sure that the person understands your wishes and is willing to take the responsibility.

You have the right to revoke this advance health care directive or replace this form at any time, except that you may not revoke this declaration when you are determined not to be competent by a court, by two physicians, at least one of whom shall be a psychiatrist, or by both a physician and a professional mental health clinician.

PART 1 DURABLE POWER OF ATTORNEY FOR HEALTH CARE DECISIONS

I designate the following individual as my agent to make health care decisions for me:

City _ ___________________ State_____ Zip ___________

(5) NOMINATION OF GUARDIAN. If a guardian of my person needs to be appointed for me by a court, I nominate the agent designated in this form. If that agent is not willing, able, or reasonably available to act as guardian, I nominate the alternate agents whom I have named under (1) above, in the order designated.

Home Phone _______________ Work ________________

PART 2

Name ____________________________________________ Address __________________________________________

OPTIONAL: If I revoke my agent’s authority or if my agent is not willing, able, or reasonably available to make a health care decision for me, I designate as my first alternate agent: Name ____________________________________________ Address __________________________________________ City _ ___________________ State_____ Zip ___________ Home Phone _______________ Work ________________ OPTIONAL: If I revoke the authority of my agent and first alternate agent or if neither is willing, able, or reasonably available to make a health care decision for me, I designate as my second alternate agent: Name ____________________________________________ Address __________________________________________ City _ ___________________ State_____ Zip ___________ Home Phone _______________ Work ________________ (2) AGENT’S AUTHORITY. My agent is authorized and directed to follow my individual instructions and my other wishes to the extent known to the agent in making all health care decisions for me. If these are not known, my agent is authorized to make these decisions in accordance with my best interest, including decisions to provide, withhold, or withdraw artificial hydration and nutrition and other forms of health care to keep me alive, except as I state here: _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ (Add additional sheets if needed.)

Under this authority, “best interest” means that the benefits to you resulting from a treatment outweigh the burdens to you resulting from that treatment after assessing (A) the effect of the treatment on your physical, emotional, and cognitive functions; (B) the degree of physical pain or discomfort caused to you by the treatment or the withholding or withdrawal of treatment; (C) the degree to which your medical condition, the treatment, or the withholding or withdrawal of treatment, results in a severe and continuing impairment; (D) the effect of the treatment on your life expectancy; (E) your prognosis for recovery, with and without the treatment; (F) the risks, side effects, and benefits of the treatment or the withholding of treatment; and (G) your religious beliefs and basic values, to the extent that these may assist in determining benefits and burdens.

(3) WHEN AGENT’S AUTHORITY BECOMES EFFECTIVE. Except in the case of mental illness, my agent’s authority becomes effective when my primary physician determines that I am unable to make my own health care decisions unless I mark the following box.

In the case of mental illness, unless I mark the

INSTRUCTIONS FOR HEALTH CARE If you are satisfied to allow your agent to determine what is best for you in making health care decisions, you do not need to fill out this part of the form.

If you do fill out this part of the form, you may strike any wording you do not want. There is a state protocol that governs the use of do not resuscitate orders by physicians and other health care providers.

You may obtain a copy of the protocol from the Alaska Department of Health and Social Services.

A “do not resuscitate order” means a directive from a licensed physician that emergency cardiopulmonary resuscitation should not be administered to you.

(6) END-OF-LIFE DECISIONS. Except to the extent prohibited by law, I direct that my health care providers and others involved in my care provide, withhold, or withdraw treatment in accordance with the choice I have marked below: (Check only one box.) [ ] (A) Choice To Prolong Life I want my life to be prolonged as long as possible within the limits of generally accepted health care standards; OR [ ] (B) Choice Not To Prolong Life I want comfort care only and I do not want my life to be prolonged with medical treatment if, in the judgment of my physician, I have (check all choices that represent your wishes) [ ] a condition of permanent unconsciousness: a condition that, to a high degree of medical certainty, will last permanently without improvement; in which, to a high degree of medical certainty, thought, sensation, purposeful action, social interaction, and awareness of myself and the environment are absent; and for which, to a high degree of medical certainty, initiating or continuing life-sustaining procedures for me, in light of my medical outcome, will provide only minimal medical benefit for me; or [ ] a terminal condition: an incurable or irreversible illness or injury that without the administration of life-sustaining procedures will result in my death in a short period of time, for which there is no reasonable prospect of cure or recovery, that imposes severe pain or otherwise imposes an inhumane burden on me, and for which, in light of my medical condition, initiating or continuing life-sustaining procedures will provide only minimal medical benefit;

[ ] additional instructions: ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________

(C) Artificial Nutrition and Hydration. If I am unable to safely take nutrition, fluids, or nutrition and fluids (check your choices or write your instructions), [ ] I wish to receive artificial nutrition and hydration indefinitely; [ ] I wish to receive artificial nutrition and hydration indefinitely, unless it clearly increases my suffering and is no longer in my best interest; [ ] I wish to receive artificial nutrition and

Advance Directives continued on page 8

Page 8 • Alaska Nurse Advance Directives continued from page 7 hydration on a limited trial basis to see if I can improve; [ ] In accordance with my choices in (6)(B) above, I do not wish to receive artificial nutrition and hydration. [ ] Other instructions

___________________________________________

___________________________________________ (D) Relief from Pain. [ ] I direct that adequate treatment be provided at all times for the sole purpose of the alleviation of pain or discomfort; or [ ] I give these instructions:

___________________________________________

___________________________________________ (E) Should I become unconscious and I am pregnant, I direct that ___________________________________ _ _____________________________________________ _ _____________________________________________ (7) OTHER WISHES. (If you do not agree with any of the optional choices above and wish to write your own, or if you wish to add to the instructions you have given above, you may do so here.)

I direct that ______________________________________ __________________________________________________ __________________________________________________ Conditions or limitations: _________________________ __________________________________________________ __________________________________________________ (Add additional sheets if needed.)

PART 3 ANATOMICAL GIFT AT DEATH (OPTIONAL) If you are satisfied to allow your agent to determine whether to make an anatomical gift at your death, you do not need to fill out this part of the form.

(8) UPON MY DEATH: (mark applicable box) [ ] (A) I give any needed organs, tissues, or other body parts,

OR [ ] (B) I give the following organs, tissues, or other body parts only: My gift under (A) or (B) above is for the following purposes (mark any of the following you want): [ ] transplant; [ ] therapy; [ ] research; [ ] education. [ ] (C) I refuse to make an anatomical gift.

PART 4 MENTAL HEALTH TREATMENT (OPTIONAL) This part of the declaration allows you to make decisions in advance about mental health treatment.

The instructions that you include in this declaration will be followed only if a court, two physicians that include a psychiatrist, or a physician and a professional mental health clinician believe that you are not competent and cannot make treatment decisions. Otherwise, you will be considered to be competent and to have the capacity to give or withhold consent for the treatments.

If you are satisfied to allow your agent to determine what is best for you in making these mental health decisions, you do not need to fill out this part of the form. If you do fill out this part of the form, you may strike any wording you do not want.

February 2010 (9) PSYCHOTROPIC MEDICATIONS. If I do not have the capacity to give or withhold informed consent for mental health treatment, my wishes regarding psychotropic medications are as follows: [ ] I consent to the administration of the following medications: __________________________________________________ [ ] I do not consent to the administration of the following medications: __________________________________________________ Conditions or limitations: __________________________________________________ __________________________________________________ (10) ELECTROCONVULSIVE TREATMENT. If I do not have the capacity to give or withhold informed consent for mental health treatment, my wishes regarding electroconvulsive treatment are as follows: [ ] I consent to the administration of electroconvulsive treatment. [ ] I do not consent to the administration of electroconvulsive treatment.

Conditions or limitations: __________________________________________________ __________________________________________________ (11) ADMISSION TO AND RETENTION IN FACILITY. If I do not have the capacity to give or withhold informed consent for mental health treatment, my wishes regarding admission to and retention in a mental health facility for mental health treatment are as follows: [ ] I consent to being admitted to a mental health facility for mental health treatment for up to_ ___d ays.

(The number of days not to exceed 17.) [ ] I do not consent to being admitted to a mental health facility for mental health treatment.

Conditions or limitations: __________________________________________________ __________________________________________________ OTHER WISHES OR INSTRUCTIONS __________________________________________________ __________________________________________________ __________________________________________________ Conditions or limitations: __________________________________________________

PART 5 PRIMARY PHYSICIAN (OPTIONAL) (12) I DESIGNATE THE FOLLOWING PHYSICIAN AS MY PRIMARY PHYSICIAN: Name of Physician ________________________________ Address __________________________________________ City _ ___________________ State_____ Zip ___________ Phone ______________________ OPTIONAL: If the physician I have designated above is not willing, able, or reasonably available to act as my primary physician, I designate the following physician as my primary physician: Name of Physician_ _______________________________ Address __________________________________________ City _ ___________________ State_____ Zip ___________ Phone ______________________ (13) EFFECT OF COPY. A copy of this form has the same effect as the original.

(14) SIGNATURES. In the presence of the witnesses or notary public, sign and date the form here: __________________________________________________ Signature Date __________________________________________________ Printed Name Address __________________________________________ City _ ___________________ State_____ Zip ___________ (15) WITNESSES. This advance care health directive will not be valid

for making health care decisions unless it is (A) signed by two (2) qualified adult witnesses who are personally known to you and who are present when you sign or acknowledge your signature; the witnesses may not be a health care provider employed at the health care institution or health care facility where you are receiving health care, an employee of the health care provider who is providing health care to you, an employee of the health care institution or health care facility where you are receiving health care, or the person appointed as your agent by this document; at least one of the two witnesses may not be related to you by blood, marriage, or adoption or entitled to a portion of your estate upon your death under your will or codicil; or (B) acknowledged before a notary public in the state.

ALTERNATIVE NO. 1 WITNESS WHO IS NOT RELATED TO OR A DEVISEE OF THE PRINCIPAL: I swear under penalty of perjury under AS 11.56.200 that the principal is personally known to me, that the principal signed or acknowledged this durable power of attorney for health care in my presence, that the principal appears to be of sound mind and under no duress, fraud, or undue influence, that I am not (1) a health care provider employed at the health care institution or health care facility where the principal is receiving health care; (2) an employee of the health care provider providing health care to the principal; (3) an employee of the health care institution or health care facility where the principal is receiving health care; (4) he person appointed as agent by this document; (5) related to the principal by blood, marriage, or adoption; or (6) entitled to a portion of the principal’s estate upon the principal’s death under a will or codicil. __________________________________________________ Signature of First Witness Date __________________________________________________ Printed Name Address __________________________________________ City _ ___________________ State_____ Zip ___________ WITNESS WHO MAY BE RELATED TO OR A DEVISEE OF THE PRINCIPAL I swear under penalty of perjury under AS 11.56.200 that the principal is personally known to me, that the principal signed or acknowledged this durable power of attorney for health care in my presence, that the principal appears to be of sound mind and under no duress, fraud, or undue influence, that I am not (1) a health care provider employed at the health care institution or health care facility where the principal is receiving health care; (2) an employee of the health care provider who is providing health care to the principal; (3) an employee of the health care institution or health care facility where the principal is receiving health care; or (4) the person appointed as agent by this document. __________________________________________________ Signature of Second Witness Date __________________________________________________ Printed Name Address __________________________________________ City _ ___________________ State_____ Zip ___________ ALTERNATIVE NO. 2 ACKNOWLEDGEMENT BY NOTARY PUBLIC

State of Alaska _ ______________ Judicial District On this_________ day of______________ in the year_ ________ before me,__________________________________ (name of notary public) appeared_____________________________ , personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to this instrument, and acknowledged that the person executed it.

(Seal) __________________________________________________ Signature of Notary Public

February 2010

Ethical/Legal Questions in Nursing

by Linda Anna Webb, RN, BA, JD [This is a new column which will be repeated as questions are submitted to the columnist.]

Question Presented: Should a nurse have a personal relationship, that is, sexual, with a former patient?

Answer: Nurses are more than caregivers.

They educate, counsel, and are seen as persons of some authority, and are to be trusted, by those uneducated in health care issues. Nursing regulations address each of these roles. Some of the regulations are straight forward, other are more subtle.

The nurse’s multiple roles become complicated when the nurse has a sexual relationship with a former client/patient. There is Alaska case law which involved a behavioral health counselor and a former client/patient. A sexual relationship developed at the end of the counseling and continued after the woman was no longer treated.

The relationship eventually deteriorated.

The former patient sued the counselor and his employer. The case was determined by the Supreme Court which held that the employer was liable to the woman on a theory of respondeat superior, that is, let the employer answer, because the relationship began during the scope of the counselor’s work and that the employer, although unaware of the relationship, was liable for the woman’s damages because the health care provider did not control “counter transference” which was part of the training, and knowledge of the counselor.

The rulings in this case can be easily applied to a nurse who receives psychiatric training, during nursing school, and should understand the concept of transference and counter transference.

A nurse who involves her/himself with a former client/patient, therefore, leaves her/himself open to a lawsuit from the former client/patient when a sexual relationship occurs. Although an employer may be sued, the nurse may also be sued for intentional torts such as, harassment, threats, and assault/battery when either the former client/ patient or the nurse wants out of the relationship.

The ethical component is that a nurse is to “do no harm” and emotional harm may be as compensable as physical harm, which results during treatment of the patient.

In addition, offering a defense that the sexual relationship was consensual will not relieve the nurse of responsibility. A good rule is “do not enter into these types of relationships.”

[Ms. Webb is a nurse-attorney who has practiced law in Alaska for 21 years. She is a partner in the law firm of Hagans, Ahearn & Webb, located in Anchorage. Ms. Webb represents health care providers in state and federal courts. Webb, an adjunct professor at the University of Alaska, teaches legal issues for nurses. She is a member of the American Association of Nurse Attorneys; AaNA and ANA; Sigma Theta Tau, Inc.; the Alaska Bar and Anchorage Bar Associations; and licensed as a registered nurse in Alaska and New York. Ms. Webb may be reached at (907)276-5294 or haw@ alaska.net.]

Alaska Nurse • Page 9

Spring Update

Alaska Nurse Practitioner Association Karen Niedermier, Secretary Happy New Year from the Alaska Nurse Practitioner Association! The ANPA has a new leadership lineup working to support the nurse practitioners of Alaska.

The ANPA met in the fall for a very fruitful strategic planning retreat, with several shortand long-term goals identified. Goals include increased collaboration with professional partners; enhanced communication among nurse practitioners; advanced public knowledge of the nurse practitioner role; increased member retention and recruitment; and increased educational opportunities for nurse practitioners.

For the complete text, including specific objectives and planned actions, visit our website at www. alaskanp.org.

In an effort to facilitate communication, we have made a few technological changes. Instead of paying for a virtual voicemail box, we now own a tangible cell phone. As the secretary and keeper of the phone, I’m doing my best to check the messages at least every few days, and either return the call or pass the message along to the most appropriate person. Also, we are now using the Alaska Nurses Association faxline at 272-0292. We hope this will eliminate some problems that arose last year, when using a member’s office fax number resulted in some confusion and lost conference registrations.

Most exciting, we are currently reviewing bids for an extensively remodeled website. We hope the new site will allow virtual access to conference registration and handouts, as well as the ANPA directory and listserve.

Lastly, planning is underway for the annual fall ANPA conference. Mark your calendars for Sept 16,17, and 18, 2010 at the Anchorage Marriott! To help with anything from speaker recruitment to conference-time logistics, contact Linda Holmes at ldholmes@alaskaspineinstitute.com.

It’s going to be a great year!

National Healthcare Decisions Day April 16th will mark the 3rd Annual National Healthcare Decisions Day. According to their website, www.nationalhealthcaredecisionsday. org, NHDD is a collaborative effort of national, state and community organizations committed to ensuring that all adults with decision-making capacity in the United States have the information and opportunity to communicate and document their healthcare decisions regarding advanced directives.

The organization encourages all Americans to voice their wishes and take steps to ensure that their choices and known and protected.

National Healthcare Decisions Day is an initiative to encourage patients to express their wishes regarding healthcare through conversations and the completion of advance directives.

The U.S. Agency for Healthcare Research and Quality (www. ahrq.gov) reported in 2003 that less than 50 percent of the severely ill or terminally ill patients studied had an advance directive in their medical record. Between 65-76 percent of physicians whose patients had an advance directive were not aware it existed.(1) Here in Alaska, only an estimated 20% of the population have advance directives.(2) The NHDD website has information, website links and downloads about advance directives. See the website for local, state or national activities.

References: 1. www.ahrq.gov “Advance Care Planning: Preferences for Care at the End of Life”, (2003) 2. Governor’s Advance Directive Proclamation.

Alaska (4/2008)

Page 10 • Alaska Nurse

Thank You From AaNA To all the Nurses who generously Gave their time and input Returning the Survey on Mandatory Overtime

February 2010

Summary of Alaska’s House Bill No. 50 & Senate Bill No. 12: “Safe Nursing & Patient Care Act” In September 1, 2009, Texas became the 15th state to prohibit the practice of forcing nurses to work mandatory overtime. In Alaska, similar legislation started the session in the State House and Senate Finance Committees. HB 50 sponsored

by Rep. Peggy Wilson (R) and SB 12 sponsored by Sen. Bettye Davis (D) have been making their way through the legislature and sponsors hope to pass the bill this session. This bill is supported by the Alaska Nurses Association who encourages all nurses to send letters of support to their legislators.

If you have questions feel free to contact Donna Phillips at the AaNA office, 907-274-0827. A summary of the bill is provided by the AaNA below. The full text of SB 12 follows the summary.

The Senate and House bill are quite similar but the Senate bill was chosen because it was a little shorter which helped with space constraints.

The Safe Nursing & Patient Care Act Will: • Protect patients and nurses in a health care facility by limiting forced overtime unless needed for an emergency. A health care facility cannot force a nurse to work beyond certain prescribed periods of time, or to accept an assignment of overtime if, in the judgment of the nurse, the overtime would jeopardize patient safety or employee safety.

• Nurses cannot work more than 14 consecutive hours without 10 hours of rest. Nurses can volunteer to work additional shifts beyond this limit, as long as the nurse does not work more than 14 consecutive hours without 10 hours of rest.

• Exceptions are allowed for unforeseen emergencies, school nurses, medivac flights, and certain on-call situations.

Why is the legislation needed?

• Purpose of bill is to promote patient safety and better working conditions for nurses.

• Nurses in Alaska are working an excessive amount of overtime without adequate rest.

Nurses often work well beyond 12 consecutive hours, or come back within 2-4 hours of completing a 12-hour shift. In other cases, nurses are working several 12-hour shifts over consecutive days.

• In most cases, this is forced or mandated through a practice called “mandatory call”, which the hospitals freely admit is used. In some cases, this is accomplished by pressure tactics designed to get nurses to “volunteer’ for overtime hours. Suggestions of patient abandonment or assertions that nurses will be letting down co-workers are not uncommon.

• HB 50/SB12 will help with nurse recruitment and retention by prohibiting excessive amounts of overtime. The nurse workforce is aging – a ban on excessive overtime will keep these nurses working longer. Replacing a nurse routinely costs 100% to 300% of the nurse’s annual salary.

• A recent phone survey by AaNA documents that not all of the new UA nursing school graduates are being hired. The bill will not exacerbate the so-called shortage – there are additional graduates available to fill positions. It will provide hospitals with a valuable recruiting tool.

• Data suggests many hospitals are using overtime as a staffing tool. Hospitals are not hiring all available graduates and maintain vacancy rates of between 7% to 25%. It appears that many hospitals are trying to avoid hiring Full-Time Equivalent (FTE) employees.

• 83% of the Alaska RN workforce is over 40 years of age and 53% is over the age of 50.

We need to conserve the workforce we have, and at the same time not scare away the 17% of the workforce that is under age 40. People with young families are not going to stay in the profession if they are constantly being forced to work beyond their desires and what they consider safe practice with excess or mandatory overtime.

February 2010

Alaska Senate Bill No. 12

26-LS0075\S CS FOR SENATE BILL NO. 12(L&C) IN THE LEGISLATURE OF THE STATE OF ALASKA TWENTY-SIXTH LEGISLATURE— FIRST SESSION

BY THE SENATE LABOR AND COMMERCE COMMITTEE

Offered: 4/15/09 Referred: Finance Sponsor(s): SENATOR DAVIS

A BILL FOR AN ACT ENTITLED "An Act relating to limitations on mandatory overtime for registered nurses and licensed practical nurses in health care facilities; and providing for an effective date."

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: *Section 1. The uncodified law of the State of Alaska is amended by adding a new section to read: LEGISLATIVE FINDINGS AND INTENT. The legislature finds that (1) it is essential that registered nurses and licensed practical nurses providing direct patient care be available to meet the needs of patients; (2) quality patient care is jeopardized by registered nurses and licensed practical nurses who work unnecessarily long hours in health care facilities; (3) registered nurses and licensed practical nurses are leaving their profession because of workplace stresses, long work hours, and depreciation of their essential role in the delivery of quality and direct patient care; (4) it is necessary to safeguard the efficiency, health, and general well-being of registered nurses and licensed practical nurses, and the health and general well-being of the persons receiving care from registered nurses and licensed practical nurses in health care facilities; (5) it is necessary that registered nurses and licensed practical nurses be made aware of their rights, duties, and remedies concerning hours worked and patient safety; and (6) health care facilities should provide adequate and safe nurse staffing without the need for or use of mandatory overtime. *Sec. 2. AS 18.20 is amended by adding new sections to read: Article 4. Overtime Limitations for Nurses.

Sec. 18.20.400. Limitations on nursing overtime. (a) Except as provided in (c) of this section, a nurse in a health care facility may not be required or coerced, directly or indirectly, (1) to work beyond a predetermined and regularly scheduled shift that is agreed to by the nurse and the health care facility; (2) to work beyond 80 hours in a 14-day period; or (3) to accept an assignment of overtime if, in the judgment of the nurse, the overtime would jeopardize patient or employee safety. (b) Except as provided by (c) of this section, after working a predetermined and regularly scheduled shift that is agreed to by the nurse and the health care facility as authorized by (a)(1) of this section, a nurse in a health care facility shall be allowed not less than 10 consecutive hours of off-duty time immediately following the end of that work. (c) Subsection (a) of this section does not apply to (1) a nurse who is employed by a health care facility providing services for a school, school district, or other educational institution, when the nurse is on duty for more than 14 consecutive hours during an occasional special event, such as a field trip, that is sponsored by the employer; (2) a nurse voluntarily working overtime on an aircraft in use for medical transport, so long as the shift worked is allowable under regulations adopted by the Board of Nursing based on accreditation standards adopted by the Commission on Accreditation of Medical Transport Systems; (3) a nurse on duty in overtime status because of an unforeseen emergency situation that could jeopardize patient safety; in this paragraph, "unforeseen emergency situation" means an unusual, unpredictable, or unforeseen situation caused by an act of terrorism, disease outbreak, natural disaster, major disaster as defined in 42 U.S.C. 5122, or disaster emergency under AS 26.23.020 or 26.23.140, but does not include a situation in which a health care facility has

reasonable knowledge of increased patient volume or inadequate staffing because of some other cause, if that cause is foreseeable; (4) a nurse fulfilling on-call time that is agreed on by the nurse and a health care facility before it is scheduled; (5) a nurse voluntarily working overtime so long as the work is consistent with professional standards and safe patient care and does not exceed 14 consecutive hours; (6) a nurse voluntarily working beyond 80 hours in a 14-day period so long as the nurse does not work more than 14 consecutive hours without a 10-hour break and the work is consistent with professional standards and safe patient care; (7) the first hour on overtime status when the health care facility is obtaining another nurse to work in place of the nurse in overtime status; (8) a nurse who (A) is employed (i) at a psychiatric treatment hospital that treats only adolescents and children; (ii) at a residential psychiatric treatment center under AS 18.07.111 or AS 47.12.990; or (iii) at a secure residential psychiatric treatment center under AS 47.32.900; (B) voluntarily agrees to work a 16-hour shift for the period between 5:00 p.m. on a Friday and 8:00 a.m. on the Monday that immediately follows and receives pay and benefits for that work that are equal to or greater than the pay and benefits the nurse would receive for working 20 regular hours in the same position; and (C) during the period described in (B) of this paragraph does not work a 16-hour shift consecutive with another shift of eight hours or more without an intervening break of at least eight hours.

Sec. 18.20.410. Health care facility complaint process for overtime work by nurses. A health care facility shall provide for an anonymous process by which a patient or a nurse may make a complaint about staffing levels and patient safety that relate to overtime work by nurses and to limitations on overtime work by nurses under AS 18.20.400.

Sec. 18.20.420. Enforcement, offenses, and penalties. (a) The commissioner shall administer AS 18.20.400 - 18.20.469 and adopt regulations for implementing and enforcing AS 18.20.400 18.20.469. (b) A complaint alleging a violation of AS 18.20.400 - 18.20.469 must be filed with the commissioner within 30 days after the date of the alleged violation. The commissioner shall provide a copy of the complaint to the health care facility named in the filing within three business days after receiving the complaint. (c) If the commissioner finds that a health care facility has knowingly violated an overtime provision of AS 18.20.400 - 18.20.469, the following civil penalties shall apply: (1) for a first violation of AS 18.20.400 18.20.469, the commissioner shall reprimand the health care facility; (2) for a second violation of AS 18.20.400 18.20.469 within 12 months, the commissioner shall reprimand the health care facility and assess a penalty of $500; (3) for a third violation of AS 18.20.400 18.20.469 within 12 months, the commissioner shall reprimand the health care facility and assess a penalty of not less than $2,500 but not more than $5,000; (4) for each violation of AS 18.20.400 18.20.469 after a third violation of AS 18.20.400 - 18.20.469 within 12 months, the commissioner shall reprimand the health care facility and assess a penalty of not less than $5,000 but not more than $25,000. (d) As an employer, a health care facility violates an overtime provision of AS 18.20.40018.20.469 "knowingly" when the facility is either aware that its conduct is of a nature prohibited by the overtime provision or aware that the circumstances described in the overtime prohibition exist; however, when knowledge of the existence of a particular fact is required to establish that the violation was knowing, that knowledge exists when the facility is aware of a substantial probability of its existence, unless the facility reasonably believes it does not exist.

Alaska Nurse • Page 11

Sec. 18.20.430. Prohibition of retaliation. A health care facility may not discharge, discipline, threaten, discriminate against, penalize, or file a report with the Board of Nursing against a nurse for exercising rights under AS 18.20.400 - 18.20.469 or for the good faith reporting of an alleged violation of AS 18.20.400 - 18.20.469.

Sec. 18.20.440. Enforcement against prohibition of retaliation. The commissioner shall investigate every complaint alleging a violation of AS 18.20.430, and, within 90 days after the date of filing of the complaint, provide to the complainant, the Department of Law, and the health care facility named in the complaint a written determination as to whether the health care facility violated AS 18.20.430. If the commissioner finds a violation of AS 18.20.430, the commissioner shall request that the Department of Law represent the department and the complainant and obtain from the health care facility all appropriate relief, including rehiring or reinstatement of the complainant to the complainant's former position with back pay.

Sec. 18.20.450. Report requirements. A health care facility shall file with the division of labor standards and safety, Department of Labor and Workforce Development, a semiannual report.

The report for the six-month period ending June 30 must be filed before the following August 1, and the report for the six-month period ending December 31 must be filed before the following February 1. The report must include, for each nurse employed by the health care facility or under contract with the health care facility, the number of overtime hours worked, the number of overtime hours that were mandatory, the number of overtime hours that were voluntary, the number of on-call hours, the number of on-call hours that were mandatory, and the number of on-call hours that were voluntary.

Sec. 18.20.460. Provisions not applicable to nurses employed in federal or tribal facilities. The provisions of AS 18.20.400 - 18.20.469 do not apply to a nurse employed in a health care facility that is operated by (1) the federal government; or (2) a tribal organization as defined in 25 U.S.C. 450b.

Sec. 18.20.469. Definitions. In AS 18.20.400 18.20.469, (1) "commissioner" means the commissioner of labor and workforce development; (2) "health care facility" means a private, municipal, or state hospital; psychiatric hospital; independent diagnostic testing facility; residential psychiatric treatment center, as defined in AS 18.07.111; skilled nursing facility; kidney disease treatment center, including freestanding hemodialysis units; intermediate care facility; ambulatory surgical facility; Alaska Pioneers' Home or Alaska Veterans' Home administered by the Department of Health and Social Services under AS 47.55; correctional facility owned or administered by the state; juvenile detention facility, juvenile detention home, juvenile work camp, or treatment facility, as defined in AS 47.12.990; private, municipal, or state facility employing one or more public health nurses; long-term care facility; or primary care outpatient facility; (3) "nurse" means an individual licensed to practice registered nursing or practical nursing under AS 08.68 who provides nursing services through direct patient care or clinical services and includes a nurse manager when delivering inhospital patient care; (4) "on-call" means a status in which a nurse must be ready to report to the health care facility and may be called to work by the health care facility; (5) "overtime" means the hours worked in excess of a predetermined and regularly scheduled shift that is agreed to by a nurse and a health care facility. *Sec. 3. The uncodified law of the State of Alaska is amended by adding a new section to read: APPLICABILITY. The first report required to be filed under AS 18.20.450, enacted in sec. 2 of this Act, shall be filed before February 1, 2010, for the period July 1, 2009, through December 31, 2009. *Sec. 4. AS 18.20.450, enacted in sec. 2 of this Act, and sec. 3 of this Act take effect July 1, 2009. *Sec. 5. Except as provided in sec. 4 of this Act, this Act takes effect January 1, 2010.

Page 12 • Alaska Nurse

Notice to AaNA Members If you have not been getting email updates and information from the Alaska Nurses Association, or if your address has changed and you are a member, please contact Donna Phillips at Donna@aknurse.org.

Alaska Nurse Alert System and Continuing Education

by LeMay Hupp, R.N., MPH, Coordinator The start of a new year is a great time to reflect and yes, maybe even make a resolution or two. The Alaska Nurse Alert System and ANAS Advisory Committee has developed a myriad of goals for 2010. As this newsletter goes to print, our web site is being revised. The changes should keep nurses updated on current events and continuing education in emergency preparedness and response.

In any given month there are numerous online courses being offered and conferences advertised on relevant topics. These will now be posted. Many of our volunteer nurses have taken advantage of the ANAS two-hour trainings over the last three years. Some of the topics covered in 2009 were: Ethical Issues in Disasters, Triage in a Mass Casualty Event, H1N1 Update and Vaccine Administration, Behavioral Issues in Disaster Care and Development of a Home Care Guide in Disease Outbreak. All of these events were offered by teleconference and provided free continuing education units!

Nursing licensure renewal is coming again this year. Don’t procrastinate! You need 30 hours of continuing education for relicensure. Alaska Nurse Alert System can help you achieve this New Year’s resolution. “Incident Command System (ICS) Made Easy” will be our Spring CE offering on Monday evening, March 22nd, 6:30 - 8:30 pm at the Alaska Nurses Association office.

These courses are advertised by email and in newsletters that go out to Alaska Nurse Alert System volunteers. For more information or to sign up for ANAS go to www.nursealert.org or call 2740827.

February 2010

Membership Application Advancing and Supporting the Profession of Nursing Integrity Professionalism ~ Advocacy Empowerment~ Representation

Membership Categories

Full Membership—Employed Full-time or Part-time Reduced Membership—Not Employed Full time student New graduate from basic Nursing Education program, within first six months after graduation (first year only), or 62 years of age or over and not earning more than Social Security allows.

Special Membership—62+ years or totally disabled (not employed)

Dues

Full

Reduced

Special

State Only Anchorage Monthly (*EDPP) & Fairbanks Yearly

$17.00 $204.00

$8.50 $102.00

$4.25 $51.00

All Other Locations

$15.87 $190.46

$7.94 $98.23

$3.97 $49.12

State (AaNA) & National (ANA-American Nurses Assoc.)

Anchorage Monthly (*EDPP) $28.67 & Fairbanks Yearly $338.00

$14.58 $169.00

$7.55 $84.50

All Other Locations

$14.27 $165.23

$7.38 $82.62

Monthly(*EDPP) Yearly

Monthly(*EDPP) Yearly

$28.04 $330.46

____________________________________________________________ Last Name/First Name/Middle Initial

______________________________ Social Security Number

____________________________________________________________ Street or PO Box City/State/Zip

______________________________ Home Phone

____________________________________________________________ Employer Name Unit City/State/Zip

______________________________ Work Phone

____________________________ RN License Number/State

__________________________ FAX Number

_______________________________ E-mail Address

Payment Method—see above for categories and amounts Check—Please make checks payable to the Alaska Nurses Association MasterCard or Visa—available for:  Annual payment

 Monthly payment

_________________________________ _____/_____ $_______ ______________________________________ Card Number Expiration Amount Signature Monthly Electronic Dues Payment *EDPP is the monthly Electronic Dues Payment Plan Amount =Yearly dues / 12 months + $.50 per month service charge 1/12 of your yearly dues will be withdrawn from your checking account monthly along with a monthly service fee. Please: (1) read and sign the below authorization form and (2) enclose a check for the first month.

AUTHORIZATION to provide monthly electronic payments to the Alaska Nurses Association (AaNA): This is to authorize AaNA to withdraw 1/12 of my annual dues and any additional service fees from my checking account designated by the enclosed check for the first month’s payment. AaNA is authorized to change the amount by giving the undersigned thirty (30) days written notice. The undersigned may cancel this authorization upon receipt by AaNA of written notification of termination twenty (20) days prior to the deduction date as designated above. AaNA will charge a $5 fee for any return drafts. ________________________________________ Signature for EDPP Authorization

Share your Expertise!

Get Informed! >>check off and return form to AaNA A Benefit of Membership: Name: ____________________________________ E-mail: ___________________________________ Informational E-mail ❏ Various Nursing Information—If you would like National, State and Local nursing information e-mails from AaNA on a weekly basis. ❏ Action Alerts—If you would like political action alerts for National and State legislative issues involving nursing and health care issues.

Taskforce Members Taskforce members will receive requests to work on a variety of projects on nursing issues, and may choose to participate in only the projects that interest them. ❏ Health and Safety Issues—Taskforces will consider safety and health issues of nurses and patients. ❏ AaNA Event Planning—Taskforces will plan events such as the AaNA Fall Retreat, open house events, AaNA General Assembly, or other events for AaNA members. ❏ Other interest? Let us know what you would like to work on:______________ AaNA Committees ❏ Legislative Committee—Actively involved in reviewing and coordinating strategy and testimony for legislative issues related to health and nursing. Works closely with the AaNA Lobbyist. Usually meets on the third Tuesday of the month. ❏ Conference Planning Team—Participates help plan the Alaska Statewide Nurses Conference. Roles include working with program planning, marketing, vendor and sponsor recruitment and onsite assistance. ❏ Continuing Education Committee—Members individually review applications for continuing education approval based on the established guidelines of the American Nurses Credentialing Center and in coordination with the CE Director. Makes recommendations for improvements in the application process. ❏ Alaska Nurse Newsletter Editorial Board—Members work with the editor to recruit articles and pictures for the quarterly newsletter. The current editor is Lynn Hartz. ❏ Professional Nursing Practice Issues— Members will consider issues relating to AaNA’s policy on RN practice and other professional issues.

Return Get Involved form, application and payment to: AaNA, 3701 E. Tudor, Suite 208, Anchorage, AK 99507 • Questions? (907) 274-0827 or (800) 811-2576

February 2010

Alaska Nurse • Page 13

Resources

December 2009 University of Alaska Nursing Graduates The University of Alaska, conferred degrees on the following students last December.

Our sincere best wishes and congratulations to you all. Welcome to our profession!

Associate of Applied Science (AAS) Nursing Graduates – Statewide Last

First

Site

Alexander Appell Behr Blackmore Boyle Carson Carver Clifton Colquhoun Cook Cruikshank Dau Denman Devens Eilers Fahey Falvey Fetzer Fisher Fontaine Fontaine Georgi Goering Grage Grieser Grogran Helfrich Hoffman James Kincaid Knapp Kueber Mahowald Mancuso Mendelsohn Nordby Olmstead Payne Ragar Reed Rose Roush SearS Slobodyanik Standley Sturrock Swift Woodworth Young

Nikole L. Amanda J. Sarah A. Jennifer A. Theresa M. Cindy K. Trisha B. Maegan B. Katherine N. Sarah R. Kathleen A. Jason E. Alica A. Angela J. Megan R. Kristin V. Rigel Edgar V. Shaina M. Christine T. Amber J. DoNna L. Keith D. Laura L. Patrick M. Lanissa D. Joy W. Leah S. Elena L. Kristen M. Roberta J. Ethel M. Greta L. Laura D. Hannah R. Emily J. Julie D. Patricia B. Abraham D. Steffanie D. Melissa G. James J. Catherine B. Valentina V. Pamela B. Rachael M. Christine Rhoda I. Sonja D.

Valdez Valdez Fairbanks Mat Su Homer Ketchikan Mat Su Juneau Fairbanks Ketchikan Fairbanks Kotzebue Fairbanks Valdez Fairbanks Ketchikan Juneau Fairbanks Homer Homer Mat Su Mat Su Juneau Fairbanks Juneau Mat Su Kotzebue Homer Ketchikan Juneau Mat Su Valdez Homer Fairbanks Juneau Fairbanks Ketchikan Homer Fairbanks Fairbanks Juneau Fairbanks Mat Su Fairbanks Ketchikan Juneau Fairbanks Mat Su Homer

Notice

Audio CD’s of recent Alaska Board of Nursing Meetings Now Available at the AaNA Office Call 907-274-0827 for copies and information Brought to you by the Alaska Nurses Association

Bachelor of Science in Nursing (BSN) Graduates – Anchorage Additional honors were given at the UAA December Recognition Ceremony to these students: Directors Award. Presented to the student with the highest GPA. In December 2009, it went to an unprecedented four students.

Melissa Hayes Cindy K. Cain Teri L. Tynan Tabitha M. Waller Spirit of Nursing Award. Conferred by faculty vote for the student they feel demonstrates the spirit of caring, science, love of learning, and compassion.

Melissa Hayes Peer Award. Presented by the senior class to a fellow classmate who has completed their nursing studies while balancing the daily demands of life.

Kerry L. McComb Pattie Arthur Joan M. Bulaong Monica J. Burnett Cindy K. Cain Kristina M. Carpenter Lindsey M. Chronister James L. Crump Haydee C. Cruz Katherine J. Dunn James E. Efird Dara M. Fields Julia A. Gluth Promise T. Hagedon Jennifer L. Hanley Sara M. Hannon Melissa Hayes Megan L. Hensley

Carey L. Idle Anna M. Kelly Rachel A. McCartan Kerry L. McComb Beryl T. Nakazawa Emily A. Reimer Christine E. Ross Jordin Schultz Nicole M. See Scott A. Smothermon Kimberly A. Tantanella Casta L. Townsley Teri L. Tynan Tabitha M. Waller Lisa M. Wassing Tyhesia E. White James H. Wright, Jr.

Medicare Payment Policies for 2010 The Centers for Medicare & Medicaid Services (CMS) recently made two important announcements regarding the reimbursement of physicians and “non-physician practitioners” such as Advanced Practice RNs (APRNs): • Beginning in January, Medicare will no longer recognize the higher paying CPT (Current Procedural Terminology) “consultation codes” which range from 99241 to 99245, and 99251 to 99255. Consulting provider visits on or after January 1, 2010 should be billed using the lower-paying evaluation and management (E/M) codes.

This cost-cutting measure also chips away at the payment disparity between primary care providers and specialists. Details are available on the CMS website at www.cms. hhs.gov/MLNMattersArticles/downloads/ MM6740.pdf.

• Anticipating a reverse by Congress of the scheduled 21.2% cut in the 2010 Medicare Physician Fee Schedule, CMS has instructed Medicare contractors to put a hold on paying such claims from January 1-15, 2010. Providers may also wait to submit these claims, avoiding the need for future adjustments. Contractors will then follow the rates in effect at that point. The hold does not affect claims for services provided before 2010. CMS has also extended the 2010 Annual Participation Enrollment Program end date from January 31, 2010, to March 17, 2010. [ANA Nursing World 1/7/10]

Page 14 • Alaska Nurse

February 2010

Upcoming Events American Cancer Society Daffodil Days The Daffodil, the first flower of Spring, is the American Cancer Society’s exclusive Symbol of Hope . . . that cancer will be eliminated as a major health problem.

Order Details: Cut daffodils bunch of ten flowers $10 Cut daffodils and a vase $15 “Celebrating Hope” bear and a bunch $25 Gift of Hope * $15 Flowers will be available for sale until March 25th In Anchorage *The Gift of Hope will enable the American Cancer Society to anonymously deliver a vase and one bunch of flowers to a cancer patient and will help further the mission of the American Cancer Society.

To learn more about Daffodil Days, visit our website at www.cancer.org, or contact Cheryl Evans at cheryl.evans@cancer.org or by phone at (907) 273-2068.

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Alaska State Board of Nursing— Upcoming Meetings April 7-9, 2010 agenda deadline

Juneau March 17

July 21-23, 2010 agenda deadline

Anchorage June 30

October 20-22, 2010 agenda deadline

Fairbanks Sept.29

January 19-21, 2011 agenda deadline

Anchorage Dec. 29

The Alaska Board of Nursing has a list-serve that is used to send out the latest information about upcoming meetings, agenda items, regulations being considered, and other topics of interest to nurses, employers and the public. To sign up for this free service, go to www.nursing. alaska.gov Choose the “Subscribe Now” box, just above Board Staff information.

Inquiries regarding meetings and appearing on the agenda can be directed to: Nancy Sanders, PhD RN, Executive Administrator Alaska State Board of Nursing 550 West 7th Ave, Ste 1500, Anchorage, AK 99501 Ph: 907-269-8161, fax 907-269-8196 email nancy.sanders@alaska.gov To attend by audio conference call 907-269-8161 for access number.

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PUBLIC HEALTH NURSING Conference March 9 – 11, 2010 “Promoting the Public’s Health: Partnerships for Prevention” Hotel Captain Cook, Anchorage For more information: https://www.signup4.net/public/ ap.aspx?EID=PHN217E&OID=50

RELAY FOR LIFE OF ANCHORAGE 2010 WHEN: Friday, May 21, 2010 at 6:00 pm until Saturday, May 22, 2010 at 4:00 pm.

WHERE: The Anchorage Park Strip WHAT: Try to imagine a giant moving slumber party with 500 or more guests. Teams of 8-15 walkers from businesses, churches, schools, organizations, families, and neighborhoods join with the cancer survivors (the honored guests) and their families with altering “shifts.”

HOW: One member of each team should be on the track throughout the event, whether walking, running, wheel chairing, or sitting in a lawn chair on the track. Each team participant is expected to raise a minimum of $150 in donations (not pledges for laps). The most successful fund-raisers exceed this amount by sending donation requests to friends and relatives outside our community, holding events such as garage sales, car washes, and other creative activities. SIGN-UP YOUR TEAM ONLINE! WHY: Relay For Life is a celebration of life!

Thanks to rapidly advancing technology, early detection and education about prevention, more people survive today than ever before. Relay For Life is a lot more than just another fund-raiser. It is about being a community that takes up the fight against cancer, coming together for a common cause. It serves to remind us that, although progress continues to be made in the crusade against cancer, so much more needs to be done.

For more information on how to form a team or for sponsorship opportunities, please contact: Nicki Shinners at 273-2066 nicki.shinners@cancer.org ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

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Women’s Health 2010: The 18th Annual Congress March 26-28, 2010 Washington, DC Crystal City, VA Presented by Journal of Women’s Health and VCU Institute for Women’s Health In collaboration with National Cancer Institute For inquiries contact nrivera@bioconferences.com

American Academy of Nurse Practitioners 25th National Conference for Nurse Practitioners June 23-27, 2010 Phoenix Convention Center, Phoenix, AZ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

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Second Annual Educational Conference, Integrated Case Management In Transitions of Care Saturday, April 24, 2010, 8 am-5 pm.

Sponsored by the Alaska Chapter of Case Management Society of America Where: Alaska Native Tribal Health Consortium— 4000 Ambassador Drive, Anchorage.

Pending 5-6 CEU’s for RN, CCM, SW, and LPN. Check on the website for further information; www.akcmsa.org or call Lisa Jacobson at 743-6962, or Bonnie Marcil at 306-5386.

Alaska Nurse Practitioner Association’s 27th Annual Conference September 16, 17, and 18, 2010 Anchorage Downtown Marriott www.alaskanp.org or 907-222-6847 ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

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The Fourth European Nursing Congress Older Persons: The Future of Care October 4-7, 2010, in Rotterdam, The Netherlands.

The central theme is older persons as the future of care. In this congress, nurses from all fields of health care, including homecare workers, general hospital staff, mental health professionals and caregivers for the mentally disabled, are invited to share their methods and their research findings with regard to care for older persons. You can Google for more information.

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February 2010

Alaska Nurse • Page 15

Letter to the Editor If you are interested in writing a letter to the Alaska Nurse, we are interested in printing it! Do you have comments, opinions or questions about nursing and health care in Alaska? Send your letter via email to editor@aknurse.org. Letters should be limited to 500 words or less. They may be edited for length, clarity and grammar.

Remember, the AK Nurse is published every three months so be careful about sending time sensitive material. Be sure to include your name and contact information.

Letter to the Editor: There has never been a Certified Nurse Midwife in the state legislature, and Barbara Norton hopes to be the first.

I would like to introduce you to Ms. Norton. I have known Barbara as a professional colleague for the past thirty years during which time I was the Program Manager of the Municipality of Anchorage, DHHS, Family Planning & Women’s Health Programs. I strongly support her as a candidate for the Alaska Legislature. A Certified Nurse Midwife plus a woman would hugely improve the balance in the Legislature!

Ms Norton announced her candidacy for the State House, District 21 (East Anchorage) in

August, and has been busy knocking on doors and raising money since. The house seat became open when Harry Crawford decided to run for US congress.

She has helped about 1000 women and their families give birth here in Anchorage since 1995. She currently is the owner of Midwifery & Women’s Health Care and the Geneva Woods Birth Center. After being a nurse for 32 years, she decided she could be more effective in the legislature where she will be in the position to help thousands of families at a time. And she says she is ready for “better hours”.

Barbara has had the opportunity over her career to work in hospitals, private and public clinics and the public school system. Her credentials include Women’s Health Care Nurse Practitioner, Perinatal Clinical Nurse Specialist and Certified Nurse Midwife.

Barbara is a strong advocate for families and believes everyone should have access to affordable, safe health care. She believes that nurse

practitioners can be part of the solution to the problem of limited healthcare access for seniors in Alaska. And she wants to be in Juneau in 2011 to help the legislature make decisions about health care access as federal health care reform mandates. She believes with her vast experience and knowledge of running her own health care practice, she will be in a strong position to lead on health care for Alaskans.

Wouldn’t it be wonderful to have a nurse in Juneau, supporting the profession of nursing?

For more information on how you can help Barbara get to Juneau, please go to her web site, barbaranortonforstatehouse.com and sign up to be a volunteer, or consider donating to her campaign.

I’ll be supporting Barbara Norton through this election season and hope you will too!

Sincerely, V. Kay Lahdenpera, MPH, BSN, RN AaNA Member, Anchorage