The Alaska Nurse Circulation 8,000 to every Registered Nurse, Licensed Practical Nurse and Student Nurse in Alaska Volume 56 No. 3
The Official Publication of the Alaska Nurses Association
AK Nurses Honor Military RNs At Armed Forces Day Reception The Alaska Nurses Association hosted a reception in honor of nursing colleagues who have or are now serving in United States military on Saturday, May 20, Armed Forces Day. Approximately twenty nurses from Elmendorf Air Force Base Hospital, Fort Richardson and Bassett Army Hospital at Fort Greeley, Fairbanks attended. In addition, a Naval Reserve Commander and an Air Force flight nurse temporarily working at Providence Alaska Medical Center pending his possible return to Iraq and a retired military nurse dropped by. The AaNA presented a six-panel piece of artwork for display at the Elmendorf hospital created through the auspices of the Foundation for Hospital Art. Major Steve Patin, Fort Richardson, was on hand to represent the foundation at the presentation. Major Patin is a foundation trustee. Col. Thomas F. Langston, USAF, Chief Nurse Executive, 3rd Medical Group, Elmendorf Air Force Base Hospital, accepted the gift on behalf of the hospital. Providence Bargaining Unit President Kathleen Gettys helped paint the piece earlier in the year at the United American Nurses Labor Assembly held in Miami, Florida. Ms. Gettys initiated conversations to obtain this particular painting for presentation to Elmendorf. The Foundation for Hospital Art has previously donated art to Elmendorf (on display in the pediatric clinic), and to military installations at Madigan Army Medical Center, Walter Reed, Brooke Army Medical Center and a score of other US military care facilities throughout the world, according to Major Patin. More about the program can be seen at www.hospitalart.org. In addition to Col. Langston, Commander Susan McDonald, U.S. Naval Reserve and Major Craig Cederberg, U.S. Air Force assisted in planning the AaNA event.
August 2006
Alaska Native Health Campus, Anchorage Page 4 Alaska Nurses in the News Page 5
From left to right, Air Force Capt. Taylor Rose, Maj. Michelle Aastrom, Lt. Astin Mills and Capt. Miriam Edourd demonstrate the armed services “can do” spirit at the Armed Forces Day reception.
Legislative Thank You’s Page 6
Inside This Issue AK Nurses Honor Military RNs At Armed Forces Day Reception. . . . . . . . . 1 The USPHS “Corp” . . . . . . . . . . . . . . . . . . . . . . 2 Spotlight: Alaska Native Health Campus, Anchorage . . . . . . . . . . . . . . . . . . . 4 Alaska Nurses in the News . . . . . . . . . . . . . . . . 5 Legislative Thank You’s . . . . . . . . . . . . . . . . . . . 6 Letter from the AaNA President . . . . . . . . . . . . 7 Opinion Poll Results . . . . . . . . . . . . . . . . . . . . . 7
Major Steve Patin, US Army, Fort Richardson and trustee for the Foundation for Hospital Art with Dianne O’Connell, Exec. Dir. AaNA in front of artwork donated to Elmendorf Air Force Base Hospital.
Alaska Nurses Association Position Paper—Administration of Dietary Supplements by RNs in Alaska. . . . . . . . . . 8 Membership Application. . . . . . . . . . . . . . . . . 11 News Briefs. . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Upcoming Events . . . . . . . . . . . . . . . . . . . . . . . 13 New Products/Publications/Resources . . . . . . 14
The AaNA Vision Empowering Alaska nurses to be dynamic leaders, powerful in both the health care and political communities.
Presort Standard US Postage
PAID Permit #14 Princeton, MN 55371
Col. Thomas Langston, Army Maj. Mark Evans, Air Force Lt. Col. Patrick O’Neill and Maj. Craig Cederberg, US Air Force Reserve in front of ANA poster asking “are you man enough to be a nurse?” Their answer is—Yes!
Page 2—Alaska Nurse—August 2006
The USPHS “Corp” by J. Pauline Stubberud, BSN, MBA Vice President, Alaska Nurses Association I wear a uniform . . . I am always receiving questions and looks of confusion when I am seen in my Commissioned Corp uniform. “I didn’t know there was a naval base in Anchorage” “Are you a cop?” “Are you a health inspector?” “Will you be closing the building?” The questions are interesting and sometimes amusing, they are also an opportunity to educate and promote who I am and what I do, along with 6,000 other officers in the United States Public Health Service. The Commissioned Corp of the United States public Health Service is one of the 7 Uniformed Services, not to be confused with Armed Services; we are health care professionals who report to the United States Surgeon General within the Department of Health and Human Services. The origin of the PHS started in 1788 when congress appointed a committee to consider a bill providing for the establishment of hospitals for sick and disabled seamen. The practice of the day was to provide free care for mariners and the growing number of sick or disabled mariners placed a burden on public hospitals. The Act was passed in 1798, and called for a tax of twenty cents per month on the salary of sailors to create a fund to provide care and construct hospitals for sailors. In 1870 a reorganization of the hospitals resulted in the establishment of the Marine Hospital Service, and the appointment of the first Supervising Surgeon (later to be known as the Surgeon General). Continued reform by the Supervising Continued on page 3
Author Guidelines for the Alaska Nurse The editorial committee welcomes original articles related to nursing for publication. Authors are not required to be members of the Alaska Nurses Association. Format and Submission Articles should be word-processed as Word documents. 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 jpeg. 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. 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 in a Word document to Editor, AK Nurse, Alaska Nurses Association, 3701 East Tudor Road Ste 208, Anchorage, AK 99507. If you have any questions call Lynn Hartz 907-248-4877 or email lhartz@alaska.com.
An official publication of the Alaska Nurses Association, 3701 East Tudor Rd., Ste. 208, Anchorage, AK 99507. Tel: 907/2740827. Web site: www.aknurse.org. Published quarterly. Materials may not be reproduced without written permission from the Editor. Views stated may not necessarily represent those of the Alaska Nurses Association. Editor: Lynn E. Hartz, MSN, FNP lhartz@alaska.com AaNA Board of Directors President: Debbie Thompson BSN, RN, CNOR Vice President: J. Pauline Stubberud, BSN, MBA Secretary: Gail M. Holtzman, MSN, CCRN Treasurer: Martha Clinehens, RN Directors: Labor Council Chair: Donna Phillips, BSN, RN Greater Alaska Director: Sara M. Harvison, RN, BSN Staff Nurse Director: Geri Brady Kelly, RNC Rural Director: Nancy Davis MS, RN Director at Large: Lynn E. Hartz, MSN, ANP Julie Torres, RN Susan Walsh, RN Lonnie Hosley, RN AaNA Labor Council Chair—Donna Phillips, RN, BSN Secretary—Joe Peacott, RN, OCN Treasurer—Carol Clausson, RN-C Sheri Whitethorn, BSN, RN, CCRN Deni Callahan, RN Jenni Hancock, RN UAN Rep.—Kathleen A. Gettys, RN, BSN, BA PAMC BU Rep.—Marlene Brehmer, RN Soldotna BU Rep.—Janet Hilleary, RN Ketchikan BU Rep.—Susan Walsh, RN Affiliate Organizations: Alaska Chapter of the American College of Nurse Midwives Alaska Nurse Anesthetists Association Alaska Nurse Practitioner Association Alaska School Nurses Association Forensic Nurses Association, Alaska Chapter Executive Director: Dianne O’Connell, M.Div. Advertising Rates Contact—Arthur L. Davis Publishing Agency, Inc., 517 Washington St., P.O. Box 216, Cedar Falls, IA 50613, 800-626-4081. 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.
August 2006—Alaska Nurse—Page 3
USPHS “Corp” – Continued Continued from Page 2 Surgeon resulted in adoption of a military model which was then formalized to the Commissioned Corp by legislation enacted in 1889. The health care needs and issues of the 19th century included not only care for mariners but the control of contagious diseases as well. Quarantine for infectious diseases was left up to states to enforce with much variability and often non-existent enforcement. A yellow fever epidemic in New Orleans in 1877 grabbed public attention and resulted in the Quarantine Act of 1878, conferring quarantine authority to the Marine Hospital Service. Expanding the service provided to the United States the Marine Hospital Service accepted responsibility for medical inspection of immigrants arriving in the US. The Service played a major role in preventing the entry of contagious diseases into the United States. In 1912, due to the continuously expanding role of the service, the name of the organization was changed to the Public Health Service. Since that time the CC has been involved in infectious disease control and prevention, playing major roles in eradication and control of diseases such as smallpox, trachoma, Hookworm, Hansen’s Disease, Pellagra, venereal disease, and yellow fever among many others. Regulating food and drugs, conducting biomedical research, providing for
sanitation and sewage, providing care for “mental hygiene” and drug addiction, health care for underserved populations, and providing medical assistance in the after math of disasters. During the Second World War the Cadet Nurse Corp was established by a 1943 law and was administered by the PHS. Education for 85% of graduating nurses between 1943 and 1946 was paid for by the Cadet Nurse Corp. The head of the Cadet Nurse Corp was Lucille Petry Leone, later becoming the Chief Nurse Officer of the PHS and the first woman to achieve the rank of Assistant Surgeon General. The PHS Commissioned Corps of today: The mission of the Public Health Service (PHS) Commissioned Corps is to provide highly-trained and mobile health professionals who carry out programs to promote the health of the Nation, understand and prevent disease and injury, assure safe and effective drugs and medical devices, deliver health services to Federal beneficiaries, and furnish health expertise in time of war or other national or international emergencies. As one of the seven Uniformed Services of the United States, the PHS Commissioned Corps is a specialized career system designed to attract, develop, and retain health professionals who may be assigned to Federal, State or local agencies or international organizations to accomplish its mission. To accomplish this mission, the agencies/programs are designed to: • Help provide healthcare and related services to medically underserved populations: to Americans, American Indians and Alaska Natives, and to other population groups with special needs;
• Prevent and control disease, identify health hazards in the environment and help correct them, and promote healthy lifestyles for the Nation’s citizens; • Improve the Nation’s mental health; • Ensure that drugs and medical devices are safe and effective, food is safe and wholesome, cosmetics are harmless, and that electronic products do not expose users to dangerous amounts of radiation; • Conduct and support biomedical, behavioral, and health services research and communicate research results to health professionals and the public; and • Work with other nations and international agencies on global health problems and their solutions. The PHS Commissioned Corps is led by the Surgeon General and consists of approximately 6,000 officers in the following professional categories: • Dentist • Dietician • Engineer • Environmental Health • Health Services • Nurse • Pharmacist • Physician • Scientist • Therapist • Veterinarian There are many opportunities for nurses in the PHS, as well as a terrific retirement and benefit plan Love to travel? Want to make a difference? Bored by routine? Looking for a few good nurses!!
Page 4—Alaska Nurse—August 2006
Spotlight: Alaska Native Health Campus, Anchorage NATIONAL NURSES WEEK 2006 by: Rebecca Hamel, RN and Pat Dooley, RN To commemorate Florence Nightingale’s birthday and recognize National Nurses Week 2006, Alaska Native Health Campus (ANHC) nursing staff planned and participated in two pancake breakfasts, accompanied by additional festivities. The Nurse Celebration Planning Committee, composed of nurses from all over campus and lead by one of ANMC CCU’s finest, Jill Montague, RN worked hard to pull all the details together. On the early mornings of May 6th & 9th, nurses were fed a pancake breakfast graciously stirred up and flipped by physicians, administrators and fellow colleagues. In true celebratory fashion there were wonderful decorations, door prizes contributed in abundance by local businesses and display tables featuring historical nursing decorations. Displays included a computer slide show of ANHC nurses throughout the years and maps with pins to indicate where nurses had received their degrees. In the quiet, darkened room next door, there was soft, soothing music, heated massages available on Ceregem beds, and chair massages. These luxuries were also donated by community
Dr. Kevin Stange (Surgery) & Laura Sawdon (Operating Room) aka ‘Florence Nightingale for a day’ businesses. Every nurse on campus had their name entered in the drawing for over 50 donated door prizes. The combination of pancakes, massages, and prizes were a perfect compliment to say “Thank You” to nurses from nurses for the excellence of their every day practice. Everyone was welcome with a nurse as their admission ticket and the morning was spent with tables mingled with administrators, assistants, technicians, nurses, doctors and more. It was a perfect “birthday bash” for Florence Nightingale and one that truly spoke to our profession’s strength, collegiality and support. Thank you to our local supporters and to all those who participated, attended, donated and flipped!
Kevin Stange MD serving Angela “Annie” Kuiper, RN., night shift Pediatrics nurse her pancake breakfast.
August 2006—Alaska Nurse—Page 5
Alaska Nurses in the News The Alaska Nurse would like to recognize nurses who have received awards, made an exciting career move or made the News since our last issue. Readers are invited to submit items for “Alaska Nurses in the News” to editor@aknurse.org. Catherine Giessel, MS, FNP-CS was inducted as a Fellow of the American Academy of Nurse Practitioners (AANP). AANP Fellows are recognized for making outstanding contributions and innovations to health care through clinical practice, research, Catherine Giessel education or public policy. Giessel has a clinical practice at the Alaska Spine Institute in Anchorage and serves on the State Board of Nursing. (Published in the Anchorage Daily News, 7/11/06) Nominate an Outstanding Nurse! Nurses are vital to the mission of March of Dimes! In 2004 the Alaska Chapter began an annual award program to recognize outstanding nurses in over 15 categories of nursing. The 2006 Alaska March of Dimes Nurse of the Year Awards will be presented at a dinner and celebration on November 17th, 2006, at the Anchorage Marriott Downtown. Nomination applications are available at www.marchofdimes.com/alaska or by contacting our office. Please consider nominating a special nurse and attending the gala evening with them! Please contact me if I can help you with March of Dimes resources or opportunities. Also, if you would like to know about volunteering for March of Dimes, I would love to talk to you. Debbie Golden, MS, RN, BC Director of Program Services 255 East Fireweed Lane, Suite 102 Anchorage, AK 99516 Direct line 276-2290 Toll-free 800-478-5245 dgolden@marchofdimes.com ‘Face Brace’ takes Anchorage 6th graders to Washington DC [Editor’s note—We usually limit our stories to nurses or health-related subjects but this time we bent the rules a bit. These kids may not be nurses yet but it is health related and what an achievement!] A team of young inventors from Rogers Park Elementary School—Johna Rutz, Leif Monnett,
Left to right: John Baldwin (Coach), Sean Doyle, Johna Rutz, Bryan Wright, Leif Monnett, Bruce Engberg (Toshiba). Pictured are the regional winners from Rogers Park who went on to become national champions in their age group for their project the “Face Brace.” Sean Doyle, and Bryan Wright from Mr. John Baldwin’s sixth grade class—is the national age group champion in the ExploraVision competition sponsored by Toshiba and National Science Teachers Association (NSTA).The team won the Upper Elementary Level category for grades 4-6 and traveled to Washington D.C. June 7-11 to accept the national award. The purpose of the competition is to encourage students to combine their imaginations with the tools of science to create and explore a vision of future technology. The team’s winning “Face Brace” was designed to help burn victims. The 14th annual Toshiba/National Science Teachers Association ExploraVision Awards program is one of the world’s largest science and technology competitions. The team was chosen from a field of 4,503 entries, representing the participation of 13,942 students from the United States and Canada. The winning Anchorage team’s project, the “Face Brace,” proposes a technology that would help patients with severe facial burns recover more fully. Coached by teacher John Baldwin, the students from Rogers Elementary School envision an innovative medical treatment called the Face Brace, which would relieve
pain and promote healing of severe facial burns. Molded to match facial contours, the ultra-thin lightweight mask made of space-age material would provide medication and oxygen under pressure through a transdermal gel that would seal the mask to the patient’s face. At the regional level, a panel of 60 judges, including science educators, scientists and engineers, evaluated the written entries and selected 24 regional winners. The projects were judged on innovations that combined imagination with scientific principles. The winning teams, along with students from the other 23 regional winning teams created working Web sites to convey their ideas. Eight finalist teams were selected in May (four first- and four second-place winners). Students on each of the four firstplace teams received a $10,000 US Savings Bond. All eight finalist teams, along with their coaches and families, were invited to attend the ExploraVision Gala Awards Weekend in Washington, D.C. in June in addition to receiving their prizes. (source: http://www.alaskascienceoutreach. com/index.php/main_pages/catchitem/face_ brace_takes_anchorage_6th_graders_to_finals_ of_national_tech_contest/)
Page 6—Alaska Nurse—August 2006
Legislative Thank You’s Each year the Alaska Nurses Association expresses appreciation to individual legislators who stood up for nurses in their practice during the previous session. Here is our Thank-you list for 2006. Please thank these legislators when you see them and don’t forget to vote in the upcoming election!
Thank You to Rep. Ethan Berkowitz for standing up on the House Floor to protect the Nurse Practices Act.
Thank You to Rep. Berta Gardner (pictured above with her son) for supporting nurses on every important issue—including mandatory overtime prohibitions and protecting the Nurse Practices Act. - Thank You to Rep. Peggy Wilson for sponsoring HB271, prohibition on mandatory overtime. - Thank You to Rep. Bill Stoltze for supporting a prohibition on mandatory overtime in the House Finance Committee. - Thank You to Rep. Mike Hawker for approving $2 million to provide a wage increase for public nurses. - Thank You to Rep. Bob Lynn for co-sponsoring HB271, prohibition on mandatory overtime. - Thank You to Rep. Max Gruenberg for co-sponsoring HB271, prohibition on mandatory overtime. - Thank You to Rep. Jim Elkins for co-sponsoring HB271, prohibition on mandatory overtime. - Thank You to Senator Lyda Green for approving funding for public nursing and public health. - Thank You to Senator Con Bunde for helping to prevent further losses to Alaskan families caused by tobacco. - Thank You to Rep. Carl Gatto for supporting protections to the Nurse Practices Act.
- Thank You to Senator Donny Olson for support public health policy based on medical science and sound practice. - Thank You to Rep. Lesil McGuire for making sure nurses were heard on important bills late in the legislative session. - Thank You to Rep. Harry Crawford for constantly protecting the rights and benefits of injured workers. - Thank You to Rep. Beth Kerttula for always seeking input and advice from nurses when important health bills are scheduled in Committee. - Thank You to Rep. John Harris for making an extra effort to meet and listen with nurses in Juneau last session. - Thank You to Senator Hollis French for sponsoring legislation that would provide financial aid to Alaska nursing students. - Thank You to Rep. Bruce Weyhrauch for sponsoring a bold effort to stop Fetal Alcohol Syndrome in Alaska. - Thank You to Rep. Tom Anderson for sponsoring a bill that provides insurance coverage for colorectal screening tests. - Thank You to Rep. Jay Ramras for sponsoring a bill that tests the hearing of newborn infants.
August 2006—Alaska Nurse—Page 7
Opinion Poll Results Letter from the AaNA President Dear Nurse Colleagues: In the last legislative session, Representative Mike Kelly introduced HB467, relating to the administration of dietary supplements by registered nurses. The Alaska Nurses Association (AaNA) was asked to address this issue by both Rep. Kelly and the AaNA general membership. Of particular interest is how this issue affects long-term care residents in Alaska. The AaNA Professional Practice Committee took up the question and began preparing a position paper regarding this issue. Nurses from across Alaska volunteered numerous hours researching, discussing, and finalizing a position paper entitled “Administration of Dietary Supplements by Registered Nurses in Alaska.” Nurses also took the time to respond to a short survey about current practices regarding administration of dietary supplements in health care facilities. This data is included in the position paper, and we believe that it is the first time that data has been collected regarding this practice. The position paper in this issue of the Alaska Nurse was adopted by the AaNA Board of Directors and presented to the Alaska Board of Nursing at their June meeting. At the June meeting, the Board of Nursing also began work on a regulation project regarding nurse administration of dietary supplements to patients: AaNA has offered their assistance to the Board. The AaNA will monitor this process and offer comments whenever appropriate. I would like to take this opportunity to thank all the members of the Professional Practice Committee who contributed to this effort and invite you, the membership, to review their work. Space did not allow for the complete report to be published but it can be accessed at the AaNA website www.aknurse.org Sincerely, Debbie Thompson, RN, BSN, CNOR President Alaska Nurses Association
Report on Dietary Supplement Survey of Our Readers Sad to say, we only received six responses. Four nurses thought administration of dietary supplements should be a part of nursing practice and two thought it shouldn’t. The lack of response may reflect either a lack of interest, a poor presentation of the survey by the editor or unknown variables. Interesting or not, since the state Board of Nursing is working on regulations on this subject, further information is given in the next few pages of this edition of the Alaska Nurse. Thanks to those of you who responded; and as for the rest of you, we’ll try to think of something more interesting to ask next time! Lynn Hartz, editor
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Alaska Nurses Association Position Paper Administration of Dietary Supplements by Registered Nurses in Alaska [This is an edited version. The complete report with attachments can be accessed at www.aknurse.org.]
Dietary supplements are regulated but not approved as drugs by the Food and Drug Administration (FDA). Congress defined the term “dietary supplement” in the Dietary Supplement Health and Education Act (DSHEA) of 1994. A dietary supplement is a product taken by mouth that contains a “dietary ingredient” intended to supplement the diet. The “dietary ingredients” in these products may include: vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites. Dietary supplements can also be extracts or concentrates, and may be found in many forms such as tablets, capsules, softgels, gelcaps, liquids, or powders. They can also be in other forms, such as a bar, but if they are, information on their label must not represent the product as a conventional food or a sole item of a meal or diet. Whatever their form may be, DSHEA places dietary supplements in a special category under the general umbrella of “foods,” not drugs, and requires that every supplement be labeled a dietary supplement. (retrieved April 19, 2006 from http://www. cfsan.fda.gov/) Guiding Principles The profession of nursing is a dynamic discipline with practice boundaries shifting and growing with the expansion and change of knowledge in response to health care needs of the consumer and health care industry. A determination of whether a particular practice or technique falls within the practice of nursing must therefore rely on qualitative criteria rather than a set list of tasks as any particular list would be rapidly out of date. The profession of nursing is impacted and defined by four main institutions:
• nursing education curricula • state and national professional nursing association standards, scope of practice statements and certification bodies • state nurse practice acts • workplace job requirements. Therefore, the AaNA position on whether administration of dietary supplements by nurses in Alaska should be considered within the practice of the registered nurse depends on the evidence regarding the current status and trend in practice in the four main institutions in Alaska: education, regulation, professional association and the workplace. The AaNA Professional Practice Committee reviewed available background information that addresses the current status of nurse administration of dietary supplements related to the following: • Administration of dietary supplements in educational nursing curricula in Alaska • AaNA and ANA Standards of Practice, Scope of Practice Statement, Ethics • Alaska Nurse Practice Act • Alaska State Board of Nursing statements/ motions/minutes related to nurse administration of dietary supplements • Workplace job requirements, resources Findings—Alaska RN Curricula Education In 2006, there are three Registered Nursing education programs in Alaska, all offered by the University of Alaska Anchorage: ° Associate of Applied Science (AAS), Nursing Program ° Bachelor of Science (BS), Nursing Program ° Master of Science (MS), Nursing Program • Separate pharmacology courses are taught in the three RN curricula. • The AAS and MS pharmacology courses contain objectives that speak directly to dietary supplements and alternative therapies. The BS program intends to include objectives about dietary supplements and alternative therapies.
• Required texts for the AAS, BS, and MS pharmacology courses all include chapters about herbal/dietary supplements and alternative therapies. • Drug handbooks and a PDA with nursing software are now required for all nursing students in the AAS and BS programs. Both of these resources contain monographs about dietary supplements, charts that summarize uses, interactions, and adverse effects of dietary supplements, and supplement-drug, supplement-food, and supplementsupplement interactions.1 Findings—Professional Scope of Practice ANA Scope of Practice, Standard of Practice, Ethics Is the practice or therapy consistent with the ethical and quality standards embraced by the professional nursing community in the State? • In Alaska, the ANA Scope and Standards of Practice provide the framework for nursing practice. The ANA Code of Ethics for Nurses provides the framework for conduct of nurses. Is the practice or therapy contained in standards of practice developed by appropriate nursing associations? • The ANA Standards of Nursing Practice describes responsibilities for which nurses are held accountable. These standards reflect the values and priorities for the profession, provide direction for professional nursing practice, and is a framework for evaluation of nursing practice (Scope & Standards of Practice, American Nurses Association, 2003, p. 1). Is the nurse prepared to accept full responsibility for his/her action and be accountable to the client or patient? • The degree of responsibility for a nurse’s actions is dependent on the nurse’s preparation, knowledge and skill, and demonstrated competence. The Alaska Board of Nursing approves all nursing education programs in the State, and such approval is evidence that the curriculum is satisfactory. All registered nurses in Alaska have either successfully passed the NCLEX-RN or been granted licenses upon presentation of a valid license in another state. • The practice of registered nursing is guided by the Code of Ethics (American Nurses Association, 2001). Item #4 of the Code of Ethics states, ° The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks Continued on page 9
August 2006—Alaska Nurse—Page 9
Dietary Supplements – Continued Continued from Page 8 consistent with the nurse’s obligation to provide optimum patient care. (American Nurses Association, Code of Ethics for Nurses with Interpretative Statements, 2002, p. 16.) • When a nurse is accountable, he/she is answerable to themselves and others for his/her actions. Accountability for actions is independent of health care facilities’ policies or provider orders. • When a nurse accepts responsibility for practice, he/she continually assesses his/her competence. When a situation calls for qualifications and competencies beyond that of the nurse, he/she seeks consultation, support, and education to advance his/her competence prior to performing duties. Findings—Alaska Nurse Practice Act In 2006, there are no statutes or regulations that permit or prohibit administration of dietary supplements by a registered nurse. Under the statutory definition of “practice of registered nursing”, two statutes could broadly be interpreted to relate: Sec. AS.68.410 (9) (D) “execution of a medical regimen as prescribed by a person authorized by the state to practice medicine, and (E) performance of other acts that require education and training that are recognized by the nursing profession as properly performed by registered nurses.” The last statement in the statute is of interest, as it appears to give some statutory authority for the nursing profession to “recognize” acts as “properly performed by registered nurses” which is at the crux of this committee’s task. Findings—Alaska State Board of Nursing In 1998 the Alaska Board of Nursing published an opinion that it was “outside the scope of nursing practice to administer remedies that are not FDA approved.” (Board of Nursing minutes, December 10-11, 1998, p. 8) The Board’s position remained unchanged
in 1999. In September of 2002 the Alaska Board of Nursing passed a motion regarding dietary supplements which stated,” The Board of Nursing having considered the current lack of regulatory oversight of dietary supplements in regard to ingredients, potency and contaminants view dietary supplement administration as incurring unknown risks to clients, therefore the Board does not support nurse administration of dietary supplements at this time.”2 Although not in support, the Board’s position in 2002 no longer contained the statement that administration was “outside the scope of nursing practice” and appeared to leave the door open for change at some future “time.” Findings—Alaska Workplace Survey Summary An informal workplace survey was sent by email to nurses at various facilities in the state. Results were received from eight facilities representing all areas of the state including acute care as well as long-term care. No assisted living facilities were included. A copy of the email explanatory note and survey are included in the attachments.3 • Prescribed vitamins and minerals are administered by nurses in 100% of the 8 responding facilities. • Prescribed herbs are administered by nurses in 50% of facilities although it was noted by respondents in two facilities that those circumstances were rare. • In three out of the eight facilities nurses administer prescribed botanicals, amino acids, enzymes, organ tissues, glandulars or metabolites. • Seven out of eight facilities have a pharmacist available to consult regarding dietary supplements though one comment was that the pharmacist might refer on to the dietician if needed. • Information on dietary supplements is available to nurses at all facilities, usually through more than one modality. The Internet was most commonly listed in 7 out of 8 facilities followed by intranet (6:8), books (6:8) and drug databases (4:8). • The final question in the survey had to do with what, if any dietary supplements were administered in the facility and asked the person completing the survey to list the supplements in order of frequency. In this case, the supplements might be given by family or other
caregivers as is was not stipulated that the nurse was administering the dietary supplement. Other than multivitamins, Ensure, calcium and iron, no other supplements listed were the same from respondent to respondent. A number of supplements were listed which include; Peptamen products, potassium, glucosamine, senna, saw palmetto, black cohosh, garlic, ginkgo, thiamine, folate, pancreatic enzymes, vitamin C, zinc and magnesium. Findings-Workplace Job Requirements/ Resources Are there sufficient resources in the workplace to support this practice? • Although dietary supplements are not approved by the FDA, the United States Pharmacopoeia (USP, http://www.usp. org) has established a voluntary thirdparty evaluation process to ensure that good manufacturing processes are used in the production of supplements that have been submitted. Examples of manufacturers that participate in this program are NatureMade, Kirkland, and Schiff. Products that have been through this process carry the label, USP-Verified. The USP will not verify products that contain ingredients known to have safety concerns, such as ephedra. • ConsumerLab.com is another independent evaluator of dietary supplements. • In 2006, most acute care and long term care facilities in Alaska have access to MicroMedex, a Web-based database of prescription and over-the-counter drugs. This database is updated regularly, and contains a description of indications, mechanism of action, dose range, interactions, side effects, and adverse reactions. • The pharmacy that serves Providence Extended Care Center and the Mary Conrad Center use an OTC formulary, a generic drug formulary, and a legend drug formulary when dispensing drugs to residents. • The Natural Standard is an international multidisciplinary consortium that reviews scientific studies about herbal/dietary Continued on page 10
Page 10—Alaska Nurse—August 2006
Dietary Supplements – Continued Continued from Page 8 supplements and analyzes the evidence for efficacy. This resource requires registration and is available to health care providers in Alaska through the University of Alaska Consortium Library’s Health Sciences Information Services (HSIS, http://lib.uaa.alaska.edu/hsis/ index.php). • Medline Plus (http://www.nlm.nih.gov/ medlineplus/druginformation.html) is a public resource that also lists a summary of available scientific evidence about dietary supplements. Conclusions • Education—Nursing education curricula in Alaska now includes dietary supplements in all three Registered nursing programs that are offered. • Professional Association—Administration of medications is a core skill commonly possessed by members of the profession. Administration of vitamins and minerals are the standard of care in Alaska with limited administration of other dietary supplements. With the ready availability of basic education or continuing education in these subjects and the workplace resources available, nurses choosing to administer dietary supplements in Alaska should be able to perform this practice within the guidelines of the ANA Scope and Standards of Practice and the ANA Code of Ethics. • Alaska Nurse Practice Act—Does not preclude. Other nurse practice acts have been interpreted to incorporate new therapies. “A number of complementary therapeutic modalities have long been incorporated into standard nursing practice to assist patient in meeting
identified health needs and goals.” [retrieved from Texas http://www.bne. state.tx.us/position.htm#15.23] • State Board of Nursing—Most recent motion 2002 does not support “at this time.” • Workplace requirement—vitamins and mineral administration are a job requirement of the nurse, herbs somewhat, others dietary supplement administration seems to occur but without a pattern. • Resources available—Multiple resources regarding dietary supplements are now available to nurses including nursing textbooks, personal digital assistant databases with weekly updates, facility internet databases and pharmacist consultants. The current status and trend of practice in Alaska indicate that limited administration of dietary supplements (vitamins and minerals) by registered nurses is established, ongoing and should be recognized as properly performed by registered nurses. Educational curricula, workplace requirements and demands of the consumer are steadily pushing the boundaries further into the federal definition of dietary supplements including administration of herbs and other prescribed botanicals. The Alaska Nurses Association supports administration of dietary supplements by the registered nurse with the following recommendations: Recommendations Administration of Dietary Supplements • Facilities refrain from creating specific lists of dietary supplements that registered nurses would administer. • Registered nurses should evaluate provider orders for dietary supplements for appropriateness in the same manner as is done for orders for FDA-approved drugs.4 • When a patient/client wishes to take their own meds, and this includes dietary supplements, a AaNA recommends the following: • An authorized provider writes an order. • The patient/client must bring in all drugs in their original containers. In the case of a dietary supplement, the container must be unopened and sealed by the manufacturer. • Only dietary supplements that are manufactured by companies on the facility formulary and/or those that have been USP-verified will be administered (to ensure quality control of manufacturing).
• The pharmacist, prescriber, and registered nurse should evaluate the dietary supplement and prescribed drugs for possible interactions. • The patient’s medications and dietary supplements should be evaluated by a pharmacist, and a designation authorizing use can be placed in the patient/client’s chart. • The registered nurse has the option to decline to administer the dietary supplements. • Documentation of doses taken should follow facility policy. Suggestions include a sheet that the patient/client maintains, or the facility’s medication administration record. • In facilities without pharmacies, nurses should restrict their recommendations, counseling and administration to USP—verified dietary supplements only. No other organization in the U.S. that tests supplements is recognized in federal law as the nation’s official standard-setting body for medicines and supplements. USP standards are enforceable by the FDA. [see Attachment I] • Continuing education about dietary supplements should be available to nursing staff. • Nursing staff has 24/7 access to consultation with pharmacists, print materials, Web-based materials, and electronic materials about dietary supplements (indications, mechanism of action, dose ranges, expected outcomes, side effects and adverse reactions). Counseling Patients on Dietary Supplements When counseling individual about taking dietary supplement, nurses should use guidelines such as “Tips for the Savvy Supplement User” (US Food and Drug Administration, Center for Food Safety and Applied Nutrition: http://www.cfsan.fda.gov/~ dms/ds-savvy.html#basic) and educate patients on the following: • Dietary supplements are regulated more like foods than drugs. In many cases there are no data to show how or even if these supplements work as the manufacturer claims. • Dietary supplements can interfere with medications the patient is already taking and the patient or family should always let the nurse administering and prescriber know all medications and supplements they are taking. • Many supplements should be stopped 2-3 weeks before surgery, as they could cause unwanted changes in heart function or bleeding. • Nurses who counsel and recommend dietary supplements must be informed. The Internet is a great site to find information about dietary supplements. Consumers and professionals should be sure to use websites that are run by governmental agencies (.gov), universities (.edu), or reputable health/medical agencies such as the American Heart Association, National Institutes of Health, US Food and Drug Administration).5 Nurses counseling patients regarding dietary supplements should recommend choosing the manufacturer wisely, since the manufacture of dietary supplements is not regulated. Some companies have participated in a voluntary program from the US Pharmacopoeia (USP) that examines the company’s manufacturing processes Supplements from these companies will be marked with “USP-Verified.” No other organization in the U.S. that tests supplements is recognized in federal law as the nation’s official standard-setting body for medicines and supplements. USP standards are enforceable by the FDA.
August 2006—Alaska Nurse—Page 11
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—Not employed and 62+ years or totally disabled
* EDPP is the monthly Electronic Dues Payment Plan Amount = Yearly dues/12 months + $.50 per month service charge
Integrity ~ Advocacy Professionalism Empowerment Representation
Share your Expertise! Get Informed! >>check off and return form to AaNA
A Benefit of Membership: AaNA Member Name: ________________ E-mail:
____________________________ Informational E-mail
Dues Anchorage & Fairbanks
Monthly (*EDPP) Yearly
Full $28.00 $330.00
Reduced $14.25 $165.00
Special $7.38 $82.50
All Other Locations
Yearly Monthly (*EDPP)
$322.50 $27.38
$161.25 $13.94
$80.62 $7.21
__________________________________________________ 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 Apply Online at www.nursingworld.org—Join Today! Alaska! Check—Please make checks payable to the American Nurses Association MasterCard or Visa—(available for annual payment only) ____________________________________ Card Number
_____/_____ $_______ Expiration Amount
Return application and payment to: AaNA 3701 E. Tudor, Suite 208, Anchorage, AK 99507
____________________________ Signature
Monthly Electronic Dues Payment Please (1) read and sign the below authorization form and (2) enclose a check for the first month. 1/12 of your yearly dues will be withdrawn from your checking account monthly along with a monthly service fee. AUTHORIZATION to provide monthly electronic payments to the American Nurses Association (ANA): This is to authorize ANA 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. ANA is authorized to change the amount by giving the undersigned thirty (30) days written notice. The undersigned may cancel this authorization upon receipt by ANA of written notification of termination twenty (20) days prior to the deduction date as designated above. ANA will charge a $5 fee for any return drafts. ______________________________________________ Signature for EDPP Authorization
K Various Nursing Information—If you would like National, State and Local nursing information e-mails from AaNA on a weekly basis. K Action Alerts—If you would like political action alerts for National and State legislative issues involving nursing and health care issues.
Taskforce E-mail Pools Taskforce E-mail Pool 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. K Professional Nursing Practice Issues— Taskforces will consider issues relating to AaNA’s policy on RN practice and other professional issues. K Health and Safety Issues—Taskforces will consider safety and health issues of nurses and patients. K 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. K Other interest? Let us know what you would like to work on:______________
AaNA Committees
K 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 second Monday of the month. Current Chair is Pat Senner. K 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. K 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. The current CE Director is Norma Monsen. K 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. Return to: AaNA, 3701 E. Tudor, Suite 208, Anchorage, AK 99507 or fax (907) 272-0292 or e-mail aknurse@aknurse.org and tell us your selection.
Page 12—Alaska Nurse—August 2006
No CPR for These Fish
Nurses Kathleen Gettys and Donna Phillips relax in their off hours from Providence Alaska Medical Center fishing on the Kenai River. It looks like they are pretty successful at relaxing!
News Briefs ANA and Two State Affiliates File Lawsuit Against U.S. Dept. of HHS for Inadequate Nurse Staffing in Hospitals 06/20/06 The American Nurses Association (ANA), the New York State Nurses Association (NYSNA) and the Washington State Nurses Association (WSNA) filed a lawsuit in U.S. District Court against the Department of Health and Human Services (HHS), Thursday June 15, to remedy violations of law that require minimum standards for participation in the federal Medicare program. Specifically, the groups claim that HHS allows hospitals that fail to meet federal nurse staffing requirements to participate in Medicare, thereby endangering patients. More . . . www.nursingworld.org/PRESSREL /2006/PR061506.htm ************************************ National Council Offers E-Learning Courses with CEUs for Behavioral Health Workforce The National Council for Community Behavioral Healthcare offers more than 100 online learning courses to increase the knowledge and skills of staff serving people with mental illnesses and addiction disorders. A wide variety of courses are available on clinical, business, and management practices. Course choices include ADHD: Diagnosis and Treatment, Bipolar Disorder, HIV/AIDS, Star*D Depression Study, Drugs in the Workplace, Alcohol Use Disorders in the Homeless Population, Strategies For Reducing Suicide In Jails, Managing Teams, Supervision 101, Project Management Basics, Compliance Issues 2006 and many more. Courses offer CEU credits from the American Psychological Association, the Association of Social Work Boards, the National Board for Certified Counselors, the National Association of Alcohol and Drug Abuse Counselors, the American Nurses Credentialing Center and several state licensing boards. The National Council offers e-learning courses through an exclusive partnership with the San Diego-based Essential Learning, the largest provider of online training services to the behavioral health industry. Training services include the organizational Learning Management System, a blended approach using classroom-based, community-based, and e-learning programs. The system offers courses to multiple employees through a customized website along with automated tracking and reporting for training and licensing requirements.
E-Learning is fast becoming the training choice in the industry because of its costeffective, quick and customizable approach to workforce development. E-learning has been proven to deliver equivalent or better gains than classroom training in learning, retention, and skill transfer, with a 35 to 40 percent time savings. New e-learning courses on clinical, business, and management practices are added every month. Details and registration are available at www.nccbh.org (Click on Services/E-Learning). Courses are available to all and discounted for National Council members. The National Council for Community Behavioral Healthcare is a not-for-profit, 501(c)(3) association of 1,300 behavioral healthcare organizations that provide treatment and rehabilitation for mental illnesses and addictions disorders to nearly six million adults, children and families in communities across the country. We provide state-of-the-science information, education and technical assistance to help the workforce of these organizations achieve operational efficiencies, sharpen practice skills, and enrich the lives of the adults, children and families they serve. ************************************ OR Nurses Needed Urgently Onboard Floating Hospital Mercy Ships seeking volunteers for short-term or career service in West Africa. Founded in 1978 by Don and Deyon Stephens, Mercy Ships owns and operates a fleet of hospital ships bringing hope and healing to the poor in port cities around the world. An international, volunteer crew of professionals staffs each of the Mercy Ships. Doctors, dentists, nurses, community developers, teachers, cooks, seamen, engineers, and many others donate their time and skills to the effort. Mercy Ships has performed more than 2 million services, with a value of $250 million US in more than 50 nations and impacted more than 2.5 million lives. Statistics include: treating more than 300,000 people in village medical and dental clinics, performing 18,000 medical surgeries, 110,000 dental treatments and completing close to 350 construction and agriculture projects, including schools, clinics, orphanages and water wells. Each year more than 1,600 short-term volunteers serve with Mercy Ships. The Mercy Ship arrived in Ghana in early June to begin her most recent field assignment. The floating hospital will remain in the port of Tema, just a few miles from the national capital of Accra, through February, 2007. At present 740 patients are scheduled for operations ranging from cataract surgery to facial reconstruction for congenital and traumatic defects as well as benign tumors. The ship’s surgical calendar is now filled through the middle of November with additional patients being scheduled daily. Mercy Ships is in immediate need of additional volunteer nurses to fill vacancies in the Ghana field service surgical calendar. Qualified candidates should contact the Human Resources Office at the Mercy Ships International Center in Garden Valley, Texas, USA for more information. Interested medical professionals should contact: Mercy Ships Human Resources jobs@MercyShips.org www.mercyships.org 1-800-772-SHIP (US only)
August 2006—Alaska Nurse—Page 13
Upcoming Events Alaska Stroke Symposium 2006 The Frontier of Future Stroke Care Monday, September 25, 2006 8:00 AM–1:00 PM Alaska Regional Hospital 2801 De Barr Road, First Floor—Ivy Room Keynote Speakers David Ness, MD Neurologist Professor and Chairman of Department of Neurology Medical College of Georgia Estrada Bernard, MD Neurosurgeon Alaska Regional Hospital, Anchorage, AK Providence Medical Center, Anchorage, AK Marshall Tolbert, MD Interventional Radiologist Alaska Regional Hospital, Anchorage, AK Providence Medical Center, Anchorage, AK Brian Trimble, MD Neurologist Alaska Native Medical Center, Anchorage, AK Conference Overview To provide an overview of current practices in the evaluation and management of the acute stroke patients in Alaska and future possibilities of stroke care using tele-stroke. Conference Objectives 1. Review the state-of-the-art treatment for acute stroke 2. Review the use of tissue plasminogen activator in acute stroke 3. Review emerging new therapies in acute stroke e.g. NXY-059 and NovoSeven 4. Understand how telemedicine can improve acute stroke care delivery 5. Understand strategies to improve acute stroke care delivery in rural areas 6. Discuss the current incidence of ischemic and hemorrhagic stroke in Alaska 7. Review the latest Neuro-interventional procedures available for acute stroke care 8. Describe the development of the ANMC stroke registry. Topics Tele-stroke and the Rural Evaluation of Acute Ischemic Stroke (REACH) experience The State of Stroke in Alaska New Neuro-interventional Procedures for Management of Stroke Alaska Native Stroke Registry Audience: Acute care nurses in emergency and critical care settings; Medivac nurses; Emergency room physicians, Neurologists, Neurosurgeons, Radiologists and health care practitioners in telehealth settings. Continuing education credits will be available for Nurses and Physicians. Registration; $20.00 if register by Sept 13th and $30.00 after Sept 13th. To register, nurses can call Tina Roy at Alaska Regional at (907) 264-1416 or Justine Muench RN MN, Heart Disease and Stroke Prevention, (907) 465-8234, Fax (907) 465-2770. ***********************************
Alaska Nurses Association “Living in Balance” Fall Retreat Making room for the Professional, Intellectual, Physical, Emotional, Communal and Spiritual— as well as the Unexpected—in our lives September 29 and 30, 2006 Alyeska Prince Hotel, Girdwood, AK Yes we’ll be educated and updated on such professional issues as: • What’s Up with the AaNA Professional Practices Committee? • What’s Up with the Alaska State Legislature? • What’s Up with the Alaska Board of Nursing? • What’s Up with Disaster Preparedness at Your House? • That PDA-Thingy and You! (PEPID and Epocrates and your practice) But the overall focus of the weekend will be “Living in Balance” . . . with time for a little pampering and fun at one of Alaska’s premier resort hotels. Alyeska’s salt water swimming pool, and fitness center await you, as does the hotel’s new Spa which opened in July. Conference Reservations Alaska Nurses Association, 3701 East Tudor Road, Suite 208, Anchorage, AK 99507 or call 907-274-0827 for brochure. Hotel Reservations The Alyeska Prince Hotel in Girdwood is offering a special rate of $129 single/double per night, plus$10 “resort fee,” plus tax. This special guest room rate will apply three (3) days before and after the conference based on availability. Hotel reservations will be taken until September 15, 2006 on a first-come, first served basis. Reservations received after the cut-off will be accepted on a space-available basis and a higher rate. Please make reservations directly with the hotel by calling 1-907-754-2111 and state that you are attending the Alaska Nurses Association Fall Retreat. Room cancellation policy: 24 hours prior to arrival. Rooms must be guaranteed with a credit card. The hotel check-in time is 4:00 pm and checkout is 12:00 noon but we have requested “early check in.” Regardless, for those arriving early baggage may be stored with bellman. ************************************
Alaska Nurse Practitioner Association 23rd Annual Conference October 5, 6 and 7, 2006 Anchorage Downtown Marriott • • • • • • • • • • • • •
Substance Abuse Screening Osteoporosis Common Office Procedures Whiplash Anxiety Disorders Headache Pediatric UTI’s Diabetic Lipidology Internet Crimes against Children CHF 2006 Depression and Dementia in the Elderly The Nursing Practice Doctorate Restless Legs Syndrome
Brochure Available at www.AlaskaNP.org or call 907-243-3574 ************************************ 26th Annual Governor’s Safety & Health Conference Back to Basics—Safety and Health for Home and Industry When: October 29, 30, 31 2006 Where: Sullivan Arena, Anchorage, Alaska Sunday—Open to Public and Families—Bring the kids to Trick or Treat and learn Health and Safety topics Monday–Tuesday Business, General & Healthcare Industry offerings with CEU’s For more information and registration go to www.signup4com/ASAC06
Page 14—Alaska Nurse—August 2006
New Products/Publications/Resources Pandemic Flu Resources 07/12/06 The Center for Disease Control provides the latest information on Pandemic Flu via a new Web site. Visit the Web site at www. pandemicflu.gov *********************************** ANA Co-Publishes New Standard on Legal Nurse Consulting with AALNC 07/07/06 (Silver Spring, MD) Nursesbooks.org, the publishing program of ANA has just released “Legal Nurse Consulting: Scope and Standards of Practice,” co-published with the American Association of Legal Nurse Consultants. This
book outlines the expectations of the professional role in which all registered legal nurse consultants should practice. This scope statement and these updated standards of legal nurse consulting practice are meant to guide, define, and direct legal nurse consultant in all settings. It also articulates the essentials of this nursing specialty, its activities and accountabilities. It’s a core resource for nurses who have chosen this field of practice. 2006/40 pp. To order, call 1-800-637-0323. ***********************************
Joint Commission Study on Emergency Preparedness Published A new study from the Joint Commission on Accreditation of Healthcare Organizations finds that community-based preparation for and response to disasters will require more effective communication and planning among hospitals, public health agencies and community first responders—such as fire, police and emergency medical services—than currently exist. The study also found that national benchmarks are needed to measure and promote emergency preparedness planning. The study—“Integrating Hospitals into Community Emergency Preparedness Planning” by Barbara I. Braun, Ph.D.; Nicole V. Wineman, M.A., M.P.H., M.B.A.; Nicole L. Finn, M.A.; Joseph A. Barbera, M.D.; Stephen P. Schmaltz, Ph.D.; and Jerod M. Loeb, Ph.D.— appears in the June 6, 2006, issue of Annals of Internal Medicine. The study, supported in part by a grant from the Agency for Healthcare Research and Quality, is the first large-scale national assessment of how closely hospitals and their communities are collaborating and planning together for natural or other disasters. Recent natural disasters and terrorist attacks have underscored the need for health care facilities to integrate their activities with communitybased emergency preparedness efforts. “This study provides important new information about the current state of linkages between hospitals and their communities, and makes clear that neither can afford to work independently in the face of major emergencies,” says Jerod M. Loeb, Ph.D., executive vice president, Division of Research, Joint Commission. “A coordinated approach is the only way to adequately serve those individuals who are victims of a disaster.” The study found that most acute care hospitals are involved in community-wide drills, analyze threats and vulnerabilities with community first responders, and are in communities which have plans for mobilizing necessary supplies, equipment, and decontamination facilities that would be required in an emergency. However, the Joint Commission study recommends drills and exercises that more truly simulate the stresses created by emergency conditions that persist over time. Other study recommendations include the creation of health care organization coalitions that can only together accurately determine the adequacy of community resources to meet identified potential needs. The study finally identifies the need for national benchmarks for objectively measuring and gauging continuous improvement in emergency preparedness planning efforts. To view the complete study, go to http:// www.annals.org/cgi/content/full/144/11/799.