Nursing matters sept 2015

September 2015 • Volume 26, Number 7

Nursingmatters www.nursingmattersonline.com

INSIDE:

What if...Behavioral Health is primary

2

Colleague Recommendations

4

Cooper Reflections

5

MADISON WI PERMIT NO. 1723

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PRST STD US POSTAGE

Higher risk is associated with working longer hours and with higher-than-average workloads.

Overtime, large workload = risk for injury Young nurses working night shifts and longer hours are at higher risk for needle sticks, muscle strains and sprains. Strains, sprains and needle sticks are among the most common non-fatal injuries associated with nursing, and research suggests that newly licensed nurses are at greater risk for these injuries than their more experienced counterparts.

A new study conducted by RN Work Project, and published in the International Journal of Nursing Studies, finds that the higher risk is associated with working longer hours and with higher-than-average workloads. Amy Witkoski Stimpfel, PhD, RN, assistant professor at the College of Nursing, New York University, led the

research team. The RN Work Project is funded by the Robert Wood Johnson Foundation.

Nurses who provide direct care frequently lift, turn and transfer patients. They also inject medications and insert intravenous lines. Those activities can result in muscle strains and sprains, and inadvertent needle sticks. Despite national policy changes, new hospital regulations and improvements in healthcare technology, these two types of injuries persist among healthcare workers, particularly those with

fewer than five years of experience.

“The majority of newly licensed nurses working in the United States work 12-hour shifts and work overtime each week,” Witkoski Stimpfel said. “Even after controlling for other factors, we found that working overtime hours was associated with needle sticks, and working night shifts was associated with sprain or strain injuries.

This suggests that more research is needed in this area to identify interventions that could reduce injury rates.”

Needle-stick injuries were also more common among nurses who were younger than 30, had a higher-than-average SEE OVERTIME, Page 5

September • 2015

Page 2

Nursingmatters

State budget changes BadgerCare

Nursingmatters is published monthly by Capital Newspapers. Editorial and business offices are located at 1901 Fish Hatchery Road, Madison, WI 53713 FAX 608-250-4155 Send change of address information to: Nursingmatters 1901 Fish Hatchery Rd. Madison, WI 53713 Editor .......................................... Kaye Lillesand, MSN 608-222-4774 • kayelillesand@gmail.com Managing Editor .................................. Julie Belschner 608-250-4320 • jbelschner@madison.com Advertising Representative...................Andrew Butzine 608-252-6263 • abutzine@madison.com Recruitment Sales Manager ......................Sheryl Barry 608-252-6379 • sbarry@madison.com Art Director ..........................................Wendy McClure 608-252-6267 • wmcclure@madison.com Publications Division Manager ................. Matt Meyers 608-252-6235 • mmeyers@madison.com Nursingmatters is dedicated to supporting and fostering the growth of professional nursing. Your comments are encouraged and appreciated. Email editorial submissions to klillesand@sbcglobal.net.

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Editor’s note: I believe this letter from Senator Kathleen Vinehout is a “must read” for all nurses. We are the ones who end up caring for the people she is discussing. Any stories you may have will certainly help in her work. Nurses are in the best position to describe how this would play out for individual patients. Please put on your advocacy hats to write or call her. Thanks, in advance, for your good work.

Wis. Sen. Kathleen Vinehout (D-31, Alma)

This letter is an update on changes related to health services passed in the recently signed state budget.

Kathleen Vinehout I want you to know the latest.

The governor’s budget put limitations on BadgerCare for childless adults – people who receive BadgerCare and do not have children under age 19 living with them – and made sweeping changes to Family Care and IRIS – Include, Respect, I Self-direct.

These changes were strongly opposed by thousands of citizen advocates. Because of people’s advocacy, some changes were

made to the governor’s budget during the Legislature’s budget deliberations.

The largest program in the state budget is Medicaid. The program provides care for more than one in five Wisconsin citizens.

Medicaid is growing faster than any other state program. In fact, about 80 percent of the increase in tax revenue in the new budget went to fund Medicaid. Such an important program deserves careful oversight. This is why I have long advocated for an audit of Medicaid, an evaluation of the program’s effectiveness and detailed analysis of the cost drivers in the program. I also expressed concern about the 20 percent increase in state dollars going to private companies to administer Medicaid.

One aspect of the Medicaid budget the Department of Health Services did not adequately anticipate was the increase in the number of childless adults seeking BadgerCare – Wisconsin’s version of acute and primary-care Medicaid. According to the nonpartisan Legislative Fiscal Bureau, the number of childless adults covered by

BadgerCare was about 60 percent higher than estimates made by Health Services staff in the last budget. These people often come into BadgerCare with no prior healthcare for many years. They often have chronic conditions that need management and medication.

The federal government offered the state money to cover categories of people new to BadgerCare. The fiscally responsible solution for Wisconsin would be to use the federal money to cover the increased number of uninsured poor adults. I strongly support using federal Medicaid expansion dollars offered under the Affordable Care Act. The Legislative Fiscal Bureau projected Wisconsin could save $360 million in state tax dollars in just this budget by accepting the federal dollars and expanding BadgerCare coverage.

Instead, the governor and those voting for the budget made several changes for childless adult BadgerCare recipients.

The changes include requiring health-risk assessments and drug screening, increasing monthly premiums, and limiting BadgerCare coverage to 48 months. But state law alone does not put these changes in place.

Federal law requires the state seek permission to make such changes because SEE VINEHOUT, Page 3

EDITORIAL BOARD Vivien DeBack, RN, Ph.D., Emeritus Nurse Consultant Empowering Change, Greenfield, WI Bonnie Allbaugh, RN, MSN Madison, WI Cathy Andrews, Ph.D., RN Associate Professor (Retired) Edgewood College, Madison, WI Kristin Baird, RN, BSN, MSH President Baird Consulting, Inc., Fort Atkinson, WI Joyce Berning, BSN Mineral Point, WI Mary Greeneway, BSN, RN-BC Clinical Education Coordinator Aurora Medical Center, Manitowoc County Mary LaBelle, RN Staff Nurse Froedtert Memorial Lutheran Hospital Milwaukee, WI Cynthia Wheeler Retired NURSINGmatters Advertising Executive, Madison, WI Deanna Blanchard, MSN Nursing Education Specialist at UW Health Oregon, WI Claire Meisenheimer, RN, Ph.D. Professor, UW-Oshkosh College of Nursing Oshkosh, WI Steve Ohly, ANP Community Health Program Manager St. Lukes Madison Street Outreach Clinic Milwaukee, WI Joyce Smith, RN, CFNP Family Nurse Practitioner Marshfield Clinic, Riverview Center Eau Claire, WI Karen Witt, RN, MSN Associate Professor UW-Eau Claire School of Nursing, Eau Claire, WI © 2015 Capital Newspapers

Include Behavioral Health in primary care?

Brenda Zarth RN, BSN

It seems logical to me that we would all need psychological help at some point in our lives.

If we have ever raised children, had a change in job or moved, or experienced divorce, sickness or loss of family memBrenda Zarth bers, we have experienced stress. Merely hearing bad news can cause the body to leak fluid from our eyes, cause our face to swell and our chest to feel heavy with pressure, can make it hard to breath, and can cause us to choke or vomit. How can we not believe that stress has physical ramifications?

Couldn’t we expect that prolonged stress might have deeper long-term damage? It’s also logical to me that a chemical pill might ease my pain and provide some relief, but I still need to learn how to move forward in my life.

In the case of acute crisis, help might include focusing on the present: “I am safe here and now, in this room, in this place.”

Healing might include focusing on breathing, to count to three when inhaling and counting to four when exhaling. Healing might be approaching life in smaller pieces – focusing

WHAT IF... on minute to minute, or hour by hour, rather than day by day. It might include helping to recognize that we all behave differently under stress, and that our thoughts and emotions do not define who we are.

Some patients become sick from having unhealthy behaviors; others stay sick because they can’t or won’t follow recommendations from their providers. Primary Care Behavioral Health in the clinic can investigate what is preventing patients from improving. It can go into an office visit after the medical doctor has completed his assessment, in order to help draft a plan of care that takes into consideration a patient’s attitudes, beliefs and behaviors.

Primary Care Behavioral Health investigates a patient’s coping ability, relationships, support, motivations and ambitions.

Assessment tools are used to identify the roots of dysfunction and to offer methods for dealing with them.

Ways of motivating patients to want to be healthy are investigated, and staff can assist a person in accepting Mental Health services more quickly. They may be able to increase the patient’s willingness to take

responsibility for their health, and work with the provider toward optimal health.

Patricia Robinson and Jeffrey Reiter, in their book “Behavioral Consultation and Primary Care: A Guide to Integrating Services” say that “up to 70 percent of Primary Care medical appointments are for problems stemming from psychosocial issues (Gatchel & Oordt, 2003).” They go on to say that “the use of psychotropic medications has gone up dramatically since the mid-1980s amongst all prescribers, and psychotropic medications are now among the most widely prescribed medications in the United States (Pincus et al.,1998).” The antipsychotic drug Abilify has the highest sales of any drug in America, according to WebMD. Another benefit of Primary Care Behavioral Health is that a consultation in a medical visit, not a mental-health visit, decreases the stigma of mental-health services. Mental health has a large percentage of no-show appointments. Primary-care physicians often see patients for depression, anxiety and copying issues, when these patients might be better served by mental-health staff.

Life is a team sport; we all need a little help now and then. Hopefully when I’m down I have friends, family or spiritual support to help me through a challenging SEE WHAT IF, Page 3

www.nursingmattersonline.com

Vinehout

continued from page 2 Medicaid is a state-federal partnership program. The Department of Health Services must seek a “waiver” from the federal Center for Medicare/Medicaid Services.

I find the governor’s 48-month limit on BadgerCare coverage particularly troubling.

Uninsured adults who qualify for BadgerCare often struggle with chronic conditions. These folks have very limited income.

They have delayed care and been locked out of the health system, or sought care in a hospital emergency room – the most costly place to receive care. To take away their health care after four years – just when they’ve finally gotten their chronic conditions under control – makes no sense. Not only is this policy immoral – it is not likely to gain federal approval.

The feds allow “waivers” as a way for states to test new ways to deliver and pay for services under Medicaid. However, after my reading of what the feds approved in other states, I suspect they will not approve a waiver to restrict care to low-income childless adults – what appears to me to be a mandatory group of beneficiaries. The Legislative Fiscal Bureau pointed out in a memo to the Joint Finance Committee that no state has gained approval from the federal government to broadly limit the length of time individuals can receive Medicaid. Additionally, no other state received approval for requiring drug testing or screening as a condition of Medicaid eligibility.

Federal law also requires an opportunity for public comment on rules waived at the request of states. This gives us an opportunity to turn advocacy efforts toward the federal level when the state submits its waiver. There will be a 30-day comment period in which the general public and stakeholders can submit comments.

I also have significant concerns with the sweeping changes proposed by the governor to Family Care and IRIS. These two programs provide long-term care services for about 55,000 people. These folks are of very modest means – less than $2,000 in assets – and are frail elderly, physically or developmentally disabled. Family Care is currently administered by non-profit managed-care organizations like Western Wisconsin Cares.

In his budget, the governor called for a complete redesign of Family Care by creating new statewide care-management organizations, putting regulation of the managed-care organizations under control of the Office of the Commissioner of Insurance, giving Health Services the authority to make significant changes in services offered, and eliminating IRIS as we know it. The governor also called for an independent assessment for all prescribed fee-for-service personal care on top of the screening already required.

The majority of the Joint Finance Committee members supported most of the governor’s changes. Actions in the committee kept the Aging and Disability Resource Centers – the one-stop shop folks can go to get help, eliminated IRIS as we know it, and changed Family Care so much that no current managed-care organization could likely continue to provide services.

The committee also allowed “any willing provider,” including many local workers and agencies, to provide services to the disabled and elderly for only the next three years. This action opens the door for a health maintenance organization – HMO – that typically limits the providers.

Self-directed options would be available under the new insurance-like plan.

However, self-directed services are fee-forservice plans and I cannot see how HMO plans could offer anything like our current IRIS program.

These actions jeopardize the

independent and self-directed care plans for thousands of individuals. In a July 13, 2015, statement, the Survival Coalition of disability groups summed up the changes as follows: “This may open the door again for creating one statewide area or few regions, and set the stage for out-of-state for-profit insurance companies.”

I have grave concerns for the continued well-being of our disabled and elderly neighbors, friends and family members, and I fear they will be subject to the conditions and profitability of a big out-ofstate for-profit insurance company. I also seriously doubt the administration’s claims the state will save money. Administrative allowances – overhead, marketing, profit, etc. – in for-profit HMOs providing BadgerCare to the state are typically 12 percent to 14 percent compared to 2 percent to 3 percent in the current non-profit Family Care program. Wisconsin will need to pay for profit in a for-profit insurance company – something taxpayers do not now pay in Family Care and IRIS. Just like changes in BadgerCare, the changes to long-term care included in the budget will require a waiver be approved

by Center for Medicare/Medicaid Services.

In my research, I found some evidence this waiver request may not be approved.

First, Center for Medicare/Medicaid Services requires Medicaid recipients in need of long-term care have an option in the delivery of services. In December 2007, the center approved Wisconsin’s waiver of Family Care with changes – if Family Care enrollees were not given options for enrollment “the State would be out of federal compliance.”

What were the changes? The state began offering the option of the IRIS program. It seems to me under the changes proposed in

continued from page 2 period. Primary Care Behavioral Health can help define strengths and amplify them, problem-solve challenges to deal with them, and help a patient move forward toward a more fluid existence.

Remember how it feels to be in love?

My husband felt light as a feather, 20 years younger, stronger than a horse; his vision was clearer, hearing more acute, and his sense of smell more vibrant. All because I said, “I love you, and I want to be with you” – simple little words. Feel the value of a smile or a “Good Job!” We all need to be reminded occasionally that challenging days will pass, and the sun will shine again.

Understand that others have been through similar pain and challenges, and survived.

If we understand the power of emotions and our psyche on health, then it makes sense

that we need to listen and assess this to achieve optimal health. When I worked in the hospital, we expected the primary care provider in the clinic to manage the patient’s overall health and adjust the plan of care. As a Home Health nurse, I averaged about 45 minutes per visit – 15 minutes to assess how my patient was feeling, 15 minutes to evaluate overall health and assess changes, and the last 15 minutes teaching and updating the plan of care.

Primary care physicians have only 15 to 30 minutes total per visit with patients to manage their care, and they have the added disadvantage of seeing patients out of their natural surroundings. Plus they see up to 32 patients a day. I can’t understand how a primary care provider can review and assess response to medications; assess overall health, coping ability, diet and bodily functions; answer questions and SEE WHAT IF, Page 4

the budget, the state once again will be out of compliance if Family Care participants are not given enrollment options.

Closely related to this requirement, under federal law states cannot require people who receive both Medicare and Medicaid from receiving care in only an HMO. At least 80 percent of the 55,000 Family Care and IRIS recipients receive both Family Care or IRIS and Medicare.

This federal law means the state must provide an alternative to the for-profit HMO – hopefully something like the current Feefor-Service IRIS program.

By April 1, 2016, the Department of Health Services must make a waiver request public and seek approval by the Legislature’s Finance Committee. This public action gives people an opportunity to see the details of the proposed system and provide comment at the state level.

Once the state submits its waiver to the federal government there will also be an opportunity for the public to weigh in with the federal government.

I very much appreciate the many people who shared stories about how changes to health programs impact them and their families. We must now all join together to stop detrimental changes through the Finance Committee and the federal Centers for Medicaid/Medicare Services.

Please know your stories and letters make a real difference. We must continue to advocate for services that provide real quality of life to those who need it the most.

Our best approach is to join together and shine a light on those who sometimes live in the shadows. We can join together in this light of compassion and understanding.

Thank you again for your continued advocacy.

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What If...

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September • 2015

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Page 4

Nursingmatters

Nurses should be immunized

SILVER SPRING, MD – The American Nurses Association is calling for all individuals, including registered nurses, to be immunized against vaccine-preventable diseases, with the only exemptions being for medical or religious reasons.

The association’s new position on immunization aligns with recommendations from the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices, a CDC panel of medical and public-health experts that advises vaccine use. The association’s re-examination of its position was prompted partly by outbreaks of measles cases this year that affected unvaccinated adults and children.

“ANA’s new position aligns registered nurses with the best current evidence on immunization safety and preventing diseases such as measles,” said ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN. “A critical component of a nurse’s job is to educate patients and their family members about the effectiveness of immunization as a safe method of disease prevention to protect not only individuals,

but also the public health.”

During the first seven months of 2015, the CDC said 183 people from more than 20 states were reported to have measles, with five outbreaks resulting in the majority of those cases. In 2000, the United States had declared that measles was eliminated from the country as a result of an effective measles vaccine and a strong vaccination program for children.

Healthcare personnel who request exemption for religious beliefs or medical contraindications – a condition or factor that serves as a reason to withhold an immunization due to the harm it would SEE IMMUNIZED, Page 6

The American Nurses Association is calling for all individuals, including registered nurses, to be immunized against vaccine-preventable diseases.

Clinical Nurse Specialists should have Doctor’s degree WASHINGTON, D.C. – The National Association of Clinical Nurse Specialists has endorsed the requirement that, by 2030, Doctor of Nursing Practice degrees be earned for entry into practice as a clinical nurse specialist. Until now, the association has consistently supported either the Master of Science in Nursing degree or the Doctor of Nursing Practice degree as adequate preparation for a clinical nurse specialist.

“In recognition of the increasingly complex needs of patients, the dramatic

What If...

continued from page 3 chart, all in a total of 15 to 30 minutes.

Sadly, most providers will admit they can’t finish in 15 minutes so they focus on the top two questions, scan the information they have, make a rushed decision and chart after hours on most of their patients.

and ongoing changes in healthcare, and the pivotal role that the (clinical nurse specialist) plays in ensuring high quality,

evidence-based, patient-centered care, (the association) has determined that the (Doctor of Nursing Practice degree) will better prepare these nurses to meet the future demands of the evolving healthcare system,” said NACNS President Peggy Barksdale, MSN, RN, OCNS-C, CNS-BC. The association’s new position also supports the recommendations of the 2010 Institute of Medicine report, “The Future of Nursing: Leading Change, Advancing Health,” and the 2009 Carnegie Foundation

report, “Educating Nurses: A Call for Radical Transformation,” to increase the number of doctorally prepared nurses.

The association also agrees with the Institute of Medicine report’s assertion that programs that allow seamless transition to higher degrees are essential to ensuring the nation has an adequate number of doctorally prepared nurses to meet future healthcare needs. Post-baccalaureate and

Most of the primary care providers I know are spending at least one to two additional hours per day charting on their own time, after hours or on their days off. Often they accept this as a requirement of the job. It’s a no-win situation and it isn’t cost effective.

I question if to make sure they aren’t missing anything, providers are ordering additional diagnostic tests including MRIs and CT scans. If providers had more time with

patients, they might feel more comfortable watching and waiting to see if patients improve in a few days.

If health care is our highest cost expense in the United States, shouldn’t we be able to expect more as providers and as patients?

To put this into perspective, we value our property so much that we pay taxes to have fire and police protection available when needed for as long as it takes to do the job.

Property is replaceable, while the human body is one per person for life.

Primary Care Behavioral Health is partially designed to address the issue of not enough time to thoroughly evaluate patients. If the problem is at least partially stress-induced, wouldn’t it make sense to try to remove or treat the stress variable to see if the physical symptoms resolve? Optimal Health Care involves a team approach; no single provider can meet the needs of all of our patients. Working with the strengths of each other, we create a win-win situation for everyone, which is more cost effective for the providers, the patient, and the insurance company.

Nurses provide an important role by triaging the background of the patient’s problems before the office visit. Nurses can organize service providers to increase efficiency and facilitate comprehensive holistic care for our patients.

Visit www.Primarycareshrink.com for more information.

Email BrendaZarth@gmail.com or visit brendashealthplan.blogspot.com with comments.

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Foundations of Faith Community Nursing Preparation Course (Latest IPNRC Curriculum) Program includes: Packet materials, IPNRC pin, & 34.0 contact hours When: October 30, 31, November 6, 7, 13, & 14, 2015 Fridays 2 – 7 pm and Saturdays 9 am – 3:30 pm Where: Viterbo University – School of Nursing, La Crosse, WI Cost: $350.00 per participant For more information call Nancy at (608)785-8500 Register by email at parishnursing@viterbo.edu

by Friday, October 23, 2015

or visit www.viterbo.edu/parishnursing for information on other offerings.

SEE SPECIALISTS, Page 6

www.nursingmattersonline.com

Page 5

September • 2015

Reprint in a series written by Signe Cooper and introduced by Laurie Glass in Nursingmatters

Erna Emma Ziegel An exemplary obstetric nurse, an author when few nurses were writing, and a well-respected teacher, Erna Ziegel served on the faculty of the University of Wisconsin-Madison School of Nursing throughout her nursing career.

She was born Jan. 22, 1912, on a farm near Beaver Dam, the oldest of four children. She graduated from Fox Lake High School, and then

enrolled in the UW-Madison School of Nursing. She was the first of her family to go to college. It was a gigantic step and showed her characteristic determination.

In 1959 she was awarded a Master’s degree from the University of Chicago. Initially appointed as a nursing instructor and clinical supervisor in obstetric and gynecologic nursing in the old Wisconsin General

Overtime

continued from page 1 workload, and lower-than-average autonomy. Autonomy was defined as the ability to work independently of others. Strains and sprains were more common among

Hospital, during her career Ziegel was to oversee the care of hundreds of mothers and babies. In later years after the hospital’s obstetric unit closed, she guided University students in their clinical experiences at St. Mary’s and Madison General Hospital in Madison.

During her tenure she saw many significant discoveries, such as the Rh factor, the relationship of birth

nurses who worked the night shift, had a higher-than-average workload, and were in poor health. Nurses working in geographical areas with more-than-average job opportunities for nurses also had a higher risk of muscle strains and sprains.

The risk for strains and sprains was lower for nurses whose first nursing degree

The data the research team analyzed were drawn from the RN Work Project’s longitudinal study of newly licensed RNs, being conducted from 2006 to 2016. Data were collected by sending a 100-question survey to nurses.

defects to German measles in pregnancy, and the significance of high doses of oxygen to the development of retrolental fibroplasia in premature babies. A major accomplishment was saving the life of a premature baby whose birth weight dropped to 13 ounces.

An excellent, innovative teacher, she was knowledgeable and enthusiastic about her subject.

was a BSN, who had higher-than-average job commitment, worked in hospitals with higher-than-average nurse-to-patient ratios, and who lived in places with higher unemployment rates.

The data the research team analyzed were drawn from the RN Work Project’s longitudinal study of newly licensed RNs, being conducted from 2006 to 2016. Data were collected by sending a 100-question survey to nurses. The final sample included 1,744 newly licensed nurses.

The other principal investigators on the team were Christine Kovner, PhD, RN,

Erna Emma Ziegel

FAAN; Mathy Mezey, professor of Geriatric Nursing at the College of Nursing, New York University; and Carol S. Brewer, PhD, RN, FAAN, UB Distinguished Professor at the School of Nursing, University at Buffalo. Kovner and Brewer direct the RN Work Project.

“New nurses experience many stressors, both physical and psychological, in their new professional roles,” Kovner said.

“Interventions that reduce those stressors not only increase nurses’ safety, but also SEE OVERTIME, Page 6

Assistant Professor of Nursing The Henry Predolin School of Nursing at Edgewood College announces the opening for two full-time tenure track faculty positions beginning with the academic year 2014-2015.

Responsibilities include teaching at the undergraduate and graduate (MSN and DNP) levels.

Graduate concentrations include Nursing Administration and Leadership.

Qualifications: • Earned PhD in Nursing (preferred), or doctorate in related field with a Master’s degree in Nursing; DNP may be considered • Eligible for RN licensure in the State of Wisconsin • Evidence of teaching, scholarly and community services potential • Knowledge and skills in contemporary practice issues related to the AACN Essentials • Demonstrated commitment to promoting diversity, inclusion, and multicultural competence

Strains and sprains are more common among nurses who work the night shift, have a higher-than-average workload, and are in poor health.

To Apply: Send a letter of application, resume, and references to: Edgewood College Human Resources – APN1 1000 Edgewood College Drive Madison, WI 53711 www.edgewood.edu E-mail: humanresources@edgewood.edu Equal Opportunity Employer

September • 2015

Page 6

Nursingmatters

CALENDAR Understanding the Gut Brain: Stress, Appetite, Digestion, and Mood Institute for Brain Potential Sept. 7 — Green Bay Sept. 9 — Madison Sept. 11 — Brookfield Visit www.ipbceu.com or call 866-6527414 for more information.

Sept. 11: The Ethics of In-Home Geriatric Care Management

Continuing Studies UW-Madison Visit continuingstudies.wisc.edu/ behavioralhealth or call 608-262-2451 for more information.

Sept. 16-18: Intoxicated Driver Program-Approved Training Continuing Studies UW-Madison Visit continuingstudies.wisc.edu/ behavioralhealth or call 608-262-2451 for more information.

Sept. 22: Fundamentals of Substance Abuse and Addiction Continuing Studies UW-Madison Visit continuingstudies.wisc.edu/ behavioralhealth or call 608-262-2451 for more information.

Nurse Manager Survival Skills: Real Strategies to Successfully Approach the Challenges PESI Healthcare

Sept. 21-22: Appleton Sept. 23-24: Brookfield Visit www.pesihealthcare.com or call 800-844-8260 for more information.

Sept. 23: Substance Abuse, Families, and Trauma-Informed Care Continuing Studies UW-Madison Visit continuingstudies.wisc.edu/ behavioralhealth or call 608-262-2451 for more information.

Immunized

adopt measures or practices in the workplace to reduce the chance of disease transmission” to patients and others, the new policy says.

The association’s position on immunization for healthcare personnel aligns with the newly revised Code of Ethics for Nurses with Interpretive Statements, which

says RNs have an ethical responsibility to “model the same health-maintenance and health-promotion measures that they teach and research,” including immunization.

The CDC recognized August as National Immunization Awareness Month to emphasize the importance of immunization across the lifespan. The week of Aug. 16-22

was focused on adult immunization and the following week of Aug. 23-29 on infant and child immunization.

The American Nurses Association represents the interests of the nation’s 3.4 million registered nurses through its constituent and state nurses associations, and its organizational affiliates.

continued from page 4 cause – should provide documentation from “the appropriate authority” supporting the request. Individuals who are granted exemption “may be required to

Specialists

continued from page 4 post-Master’s programs are the two academic routes to the Doctor of Nursing Practice degree. The latter must use approved clinical nurse specialist competencies and education standards in the curriculum to ensure graduates are prepared for clinical nurse

specialist practice.

The association developed core clinical nurse specialist competencies, and Criteria for the Evaluation of Clinical Nurse Specialist Master’s, Practice Doctorate, and Post-Graduate Certificate Educational Programs to support and guide clinical nurse specialist educators in developing and evaluating their curricula.

While the association supports the

Support is growing for the requirement that, by 2030, Doctor of Nursing Practice degrees be earned for entry into practice as a clinical nurse specialist.

Doctor of Nursing Practice degree as the appropriate degree for future clinical practice as a clinical nurse specialist, the association supports allowing clinical nurse specialists who pursued other graduate education to continue to practice without having to earn the degree, retroactively, after 2030.

Founded in 1995, the National Association of Clinical Nurse Specialists represents the clinical nurse specialist. Clinical nurse specialists are advanced-practice registered nurses who work in a variety of specialties to ensure high-quality, evidence-based patient-centered care.

1-888-VITERBO • www.viterbo.edu/nursing • La Crosse, Wisconsin

Viterbo is ...Nursing

Overtime

BSN Program

improve quality of care. Our study is part of a growing body of evidence that suggests newly licensed nurses should not work excessive overtime and should have limited night-shift work.”

Brewer said, “We did not ask questions about safety training or continuing education to help nurses avoid these kinds of injuries. Those might help mitigate such injuries, and research into that would be warranted.

It would be worthwhile to investigate other modifiable risk factors, too, like the availability and use of safety equipment, such as patient lifts.

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continued from page 5

Nurses’ fatigue and the quality and quantity of sleep they get would also be good areas for inquiry.”

The RN Work Project is a 10-year study of newly licensed registered nurses that began in 2006. It is the only multi-state, longitudinal study of new nurses’ turnover rates, intentions and attitudes – including intent, satisfaction, organizational commitment and preferences about work.

The study draws on data from nurses in 34 states and the District of Columbia, covering 51 metropolitan areas and nine rural areas.

For more than 40 years the Robert Wood Johnson Foundation has worked to improve the health and healthcare of all Americans. Visit www.rwjf.org for more information.

September • 2015

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Kleist earns recertification MEDFORD, Wis. – Misty Kleist, infection prevention coordinator at Aspirus Medford Hospital and Clinics, recently earned recertification in infection prevention and control through the Certification Board of Infection Control and Epidemiology. This achievement demonstrates Kleist’s mastery of knowledge in infection prevention and control, as Misty Kleist well as her commitment to patient and public safety.

Preventing infections in hospital and other healthcare settings has the potential to save lives, reduce illness and disability, and avoid billions of dollars in unnecessary healthcare expenses. As Aspirus Medford’s infection prevention coordinator, Kleist is responsible for planning, implementing and evaluating the organization’s infection-prevention practices and standards. She is also responsible for developing programs aimed at preventing healthcare-acquired infections among patients, residents and employees.

Kleist has been certified in infection prevention and control since 2010. She must undergo a rigorous recertification process every five years.

Nursingmatters

Mercy welcomes nurse practitioner Danielle Westmoreland

JANESVILLE, Wis. – Mercy Health System has added Danielle Westmoreland, MS, RN, APNP, PMHNP-BC, to its staff at Mercy Options Behavioral Health Services, 903 Mineral Point Ave., Janesville.

Westmoreland is an adult

psychiatric-mental-health nurse practitioner. Her special interests include bipolar disorder, depression, anxiety, ADHD and chronic mental illness. She works with adults from diverse ethnic, cultural, socioeconomic and spiritual backgrounds.

Westmoreland earned her Master of Science degree at the University of Wisconsin-Madison. She is board-certified by the American Nurses Credentialing Center as a psychiatric-mental-health nurse practitioner.

Rep. Lois Capps, Navy nurse receive awards SILVER SPRING, MD – The American Nurses Association presented Rep. Lois Capps (D-CA), RN, founder and co-chair of the Congressional Nursing Caucus, with the 2015 President’s Award during the association’s Membership Assembly Lois Capps meeting in July. Capps, who recently announced her retirement from Congress, is being honored for being a champion for nurses during her career as a lawmaker.

“Rep. Capps’ tireless advocacy on behalf of nurses is greatly appreciated

and will be sorely missed,” said ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN. “Lois is truly a special leader who brings the voice of nursing to Capitol Hill in a way that fosters a better understanding of healthcare policy decisions and their impact on healthcare professionals, individuals and the broader community. This award is ANA’s way of honoring her significant contributions.”

Prior to her tenure in Congress, Capps spent 20 years as a nurse and public healthcare advocate for the Santa Barbara School District in California.

In 2013, Capps was honored with the association’s inaugural Congressional Nurse Advocate award, which recognizes

members of Congress who champion legislation that helps the nursing profession.

The association also presented the Year of Ethics award to a Navy nurse who refused to force-feed prison detainees at Guantanamo Bay Detention Camp. The association supported the nurse as he faced dismissal from the Navy for following his professional ethical obligations. In May 2015, the United States Navy opted not to pursue further action against the Navy nurse. At the time, Cipriano said the Navy’s decision “recognizes the registered nurse’s first duty is to the patient, regardless of the setting of care or the employment situation.” The nurse has chosen not to be identified. His attorney accepted the award on his behalf.

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