Texas Nursing Magazine - Fall 2016

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TEXASNURSING M A G A Z I N E

CULTURAL HUMILITY : LGBTQ STORIES OF TRANSITION ON EACH SIDE OF NURSING

T N A : E m p o w e r i n g Te x a s N u r s e s t o a d v a n c e t h e p r o f e s s i o n | F a l l 2 0 1 6

FALL 2016 Volume 90, Number 4 EDITOR-IN-CHIEF: Cindy Zolnierek, PhD, RN MANAGING EDITOR: Kat Hinson

8501 North MoPac Expressway, Suite 400, Austin, TX 78759-1292 P: 800.TNA.2022 or 512.452.0645; F: 512.452.0648 tna@texasnurses.org | texasnurses.org

MISSION Empowering Texas Nurses to advance the profession

BOARD of DIRECTORS OFFICERS:

Jeff Watson, DNP, RN-BC, NEA-BC, NE-BC, CRRN, President

Kim Belcik, PhD, RN-BC, CNE, Vice President

Terry Throckmorton, PhD, RN, Secretary

Sarah Moody, DNP, RN, NEA-BC, Treasurer REGIONAL DIRECTORS:

Rhonda Winegar, DNP, RN, FNP-BC, CCRN, CPN, Central

Tamara “Tammy” Eades, DNP, MSN, RN, North

Pam Greene, PhD, RN, South

Patricia “Pat” Morrell, DNP, RN, NEA-BC, East

Patty Esposito, MSN, RN, NEA-BC, West EXECUTIVE DIRECTOR:

Cindy Zolnierek, PhD, RN

TNA DISTRICT AND PRESIDENT

VISION Nurses Transforming Health TEXAS NURSING (ISSN 0095-36X) is published quarterly – Winter, Spring, Summer, Fall – by the Texas Nurses Association, 8501 N. MoPac Expy., Ste 400, Austin, TX 78759-8396 Periodical Postage is paid in Austin, Texas.

One-year subscriptions: $25 (nursing schools, libraries, hospitals, non-nurses, out-of-state nurses) foreign, $30; single copy, $2.50.

Subscription is not available to non-member Texas nurses.

Some back issues may be viewed online at texasnurses.org.

Dist.1:

Paula Meagher, 915-831-4530, pmeagher@epcc.edu

Dist. 2: Sharon Brewer, 806-414-9336, sharon.brewer@ttuhsc.edu Dist. 3: Elaine Nelson, 682-518-0819, elainenelson@texashealth.org District office: 817-249-5071, tna3@usapathway.com, tna3.org Dist. 4: Jeanie Zelanko, 972-270-4691, zelanko@sbcglobal.net District office: Pat Pollock, P.O. Box 764468, Dallas, TX 75376; 972-435-2216; d4tna@flash.net; tnad4.org Dist. 5: Matthew Davis, 413-841-1319, MatthewDavisRN@gmail.com, tna5.org Dist. 6: Rachel ellis, 409-370-9600, rnellis@utmb.edu Dist. 7: Naomi Devers, nrdevers@yahoo.com, District office: P.O. Box 132, Belton, TX 76513, tnadistrict7@gmail.com

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TEXAS NURSING is indexed in The Cumulative Index to Nursing and Allied Health Literature and in the International Nursing Index.

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Statements of fact and opinion are made on the responsibility of the authors alone and do not imply an opinion on the part of the officers or the membership of TNA. POSTMASTER Send address changes to TEXAS NURSING, 8501 North MoPac Expy., Suite 400, Austin, TX 78759-8396 ARE YOU MOVING? Need to change your address? If so, provide it quickly and easily in the Members Only section of the TNA web site, texasnurses.org. Or mail us your new address – at least six weeks prior to your move – to Texas Nurses Association headquarters. We’ll make sure your TEXAS NURSING makes the move with you.

FEEDBACK EMAIL OR LETTER GUIDELINES TEXAS NURSING will select emails/letters on the basis of readership interest and relevance to current nursing/health-care events. TEXAS NURSING reserves the right to edit all letters. Guide: Limit to 200 words; focus on single issue; include writer’s name, mailing address, and daytime phone. Send to: editor@texasnurses.org.

Copyright 2016 © Texas Nurses Association

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Dist. 9: Cheryl Lindy, 281-883-8229, cmlindy@earthlink.net District office: Melanie Truong, 2370 Rice Blvd., #109, Houston, TX 77005; 713-523-3619; tna9@tnadistrict9.com; tnadistrict9.com

Dist. 11: Daria Close, 940-867-1134, daria.close@mwsu.edu Kathleen Williamson, 940-397-4610, Kathleen.williamson@mwsu.edu Dist. 12: Greg Friesz, 409-365-4952, gfriesz@mac.com Dist. 13: Nannette Kelley, nannettekelley@msn.com Dist. 14: Eloisa Tamez, 956-882-5079, eloisa.tamez@utrgv.edu Dist. 15: Andrea Kerley, 325-670-4230, akerley@hendrickhealth.org Dist. 16: Holly White, 325-656-0231, holly.white@cookchildrens.org Dist. 17: Cindy Keese, 361-332-1643, cakeese@aol.com Dist. 18: Pat Francis Johnson, 806-743-2730, ext. 237, patricia.francis@ttuhsc.edu Dist. 19: Karen Koerber-Timmons, 903-452-3004, ktimmons@uttyler.edu Dist. 20: Deborah Pena, 361-570-0356, debbie.pena@victoriacollege.edu Dist. 21: Jessica Tully, 432-254-1949, jessica.tully@midland-memorial.com Dist. 22: Toni McDonald, 936-544-8823, t.mcdonald323@yahoo.com Dist. 26: Elizabeth Adamson, 956-362-3015, e.adamson@dhr-rgv.com Dist. 28: Jessica Smallwood, 903-280-2071, jessicasmallwood@me.com Dist. 35: Chrystal Brown, 903-434-8302, cbrown@ntcc.edu Dist. 40: Contact TNA, 800-862-2022, ext. 129, brichey@texasnurses.org

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CULTURAL HUMILITY:

LGBTQ STORIES OF TRANSITION

ON EACH SIDE OF NURSING

PRACTICING WITH RESPECT:

STORY OF LEE

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COVER: photo courtesy iStock

GENDER TRANSITION: ONE NURSE’S STORY

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PRESIDENT’S NOTES

2017 POLICY POSITIONS

LET’S GET CONNECTED

2017 NURSE DAY AT THE CAPITOL

MARK YOUR CALENDARS

How Strong is Your Link?

A Review of Issues Most Important to Texas Nurses

SO YOU WANT TO BE AN APPROVED PROVIDER?

TNA’s New Online Member Community

Make Your Voice Heard

Important 2017 Dates

Know the Process

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TNA MEMBER NEWS

TNA-APPROVED CNE PROVIDERS

Kudos, Elections & Appointments

A Complete List

A UNIFIED VOICE TO ADVANCE NURSING

TNA DISTRICT LEADERS CONVENE

The APRN Alliance

2016 Fall Forum

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President’s Notes Jeff Watson, DNP, RN-BC, NEA-BC, NE-BC, CRRN

HOW STRONG IS YOUR LINK? Strengthening Support for Our Association ONE SUMMER, many years ago, my parents decided to host a family reunion at our home. In addition to our usual summer duties, we completed other preparatory tasks before the July 4th event. I seem to remember a complete transformation of the outdoor spaces surrounding our home. In reality, though, it was probably nothing more than a few flower bed changes and some paint.

Before I knew it, the big weekend was upon us. The family began to arrive from all across the country. The first was my dad’s sister. Shortly after her arrival, she and my mother were sitting out on the patio on a porch swing, which hung from a beam by very thick chains. It was a classic summer afternoon scene: dappled sunlight, a warm breeze, sweet southern iced tea, and lots of laughter. You get the picture.

Then, without warning, the swing collapsed, my mother and my aunt plummeted to the hard concrete surface below them. We all quickly helped them up and made certain no one was injured. In their usual style, my mom and aunt promptly refilled their glasses, took seats in some adjacent chairs and went right back to their conversation as if nothing had ever happened.

My dad, on the other hand, was visibly upset. He enlisted me to help figure out what went wrong and repair it. The problem: one of the thick chain links had worn through on the left side — a single weak link caused the whole structure to come crashing down.

Soon, we were off to the hardware store to purchase a new swing and chains. In no time, we resolved the problem and the remaining days of the reunion were without incident.

Every spring from that point on, my dad would carefully inspect each link in the chains that supported the swing. From time to time, we would replace links weakened from overuse.

He made sure that every component of the swing was substantial enough to provide the necessary support to last through the season.

Recently, I’ve been asking myself how we, as a family of nurses, might further strengthen our association. In considering a robust association, I offer these questions: What would that look like to you?

We need your eyes to help us see what has yet to materialize.

What would it sound like to you?

We need you to give voice to concerns yet spoken.

What would it feel like to you?

We need your stories to help us connect to the realities of the times.

I am hopeful that together, we can build a leadership infrastructure to keep TNA strong and growing stronger still with each passing legislative season. Members are needed to fill open service positions up and down the association structure. We need leaders who have invested locally and are willing to drive change at the community level. Additionally, we need state leaders who are ready to

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represent the diversity of our membership and our practice communities across Texas.

As a professional Registered Nurse, I believe we are all leaders. And yet, there are certain expectations to think about as you contemplate stepping into leadership roles. For me, there is no more accurate description of those expectations than these words penned by Mary Lou Anderson (1970): Leaders are called to stand in that lonely place Between the no longer and the not yet And intentionally make decisions That will bind, forge, move and create history. continued on page 23

MEMBER NEWS

TNA MEMBER NEWS KUDOS Janice Hooper, PhD, RN, FRE, CNE, FAAN, ANEF, Lead Education Consultant for the Texas Board of Nursing, was recently inducted as a Fellow of the National League for Nursing Academy of Nursing Education.

Hooper has combined her past role as a nurse educator with her present role as a nursing education regulator to initiate change in the culture of nursing education regulation.

TNA District 1 member Linda Lawson, DNP, RN, NEA-BC, has been named the inaugural CNO for The Hospitals of Providence Transmountain Campus, a teaching hospital in collaboration with Texas Tech University Health Sciences Center (TTUHSC) El Paso. Lawson, a Robert Wood Johnson Foundation Executive Nurse Fellow alumna, is a faculty member at TTUHSC Gayle Greve Hunt School of Nursing, and is an appraiser for the ANCC’s Magnet and Pathway to Excellence programs.

directors. He will assume the presidency Jan. 1, 2018. Cole Edmonson, (pictured below right) DNP, RN, FACHE, NEA-BC, Chief Nursing Officer at Texas Health Presbyterian Hospital, Dallas, will serve a three-year term representing Region 7 on the AONE board of directors beginning Jan. 1, 2017.

Four TNA members have been appointed by the American Nurses Association board of directors to serve on ANA committees and boards. Margie L. Dorman-O’Donnell, MSN, RN, will serve on the ANA Political Action Committee board of trustees. Rosemary Luquire, PhD, RN, NEA-BC, FAAN, was reappointed to the ANCC board of directors. Norma Elia Martinez Rogers, PhD, RN, FAAN, and Elias Vasquez, PhD, RN, FAAN, FAANP, will serve on the Minority Fellowship Program National Advisory Committee. i

ELECTIONS & APPOINTMENTS

APPLY NOW! MSN • Family Nurse Practitioner • Nurse Administrator • Nurse Educator

Aida Gonzalez, RN, a TNA member from District 26, has been appointed to the Texas Department of State Health Services (DSHS) Newborn Screening Advisory Committee.

She will serve as a hospital representative through April 2017. Gonzalez has been vice president of Women’s Hospital at Renaissance in Edinburg, Texas, since 2009.

Two TNA members were elected to leadership roles in the American Organization of Nurse Executives.

Bob Dent, (pictured left) DNP, MBA, RN, NEA-BC, CENP, FACHE, senior vice president, chief operating officer, and chief nursing officer at Midland Memorial Hospital in Midland, Texas, was elected as the 2017 president-elect of the AONE board of

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CULTURAL HUMILITY:

SEEKING TO UNDERSTAND ANOTHER’S PERSPECTIVE

By Ellen Martin, PhD, RN, TNA Director of Practice

THE LESBIAN, GAY, BISEXUAL, transgender, and queer or questioning (LBGTQ) community makes up an estimated 5 to 10 percent of the US population (Institute of Medicine [IOM], 2011). The LGBTQ community is as diverse as the nation as whole. They experience the same prevalence of health concerns as the general population and are at increased risk from disparities in some conditions and may experience stigma, insensitivity, and lack of knowledge of their unique needs. By 2050 it is estimated that 1 in 13 elders will identify as LGBTQ .

The importance of respectful communication for all patients cannot be overemphasized. The purpose of this article is to increase nurse awareness of LGBTQ issues and describe resources available to nurses for use in everyday practice. An improved understanding of the unique needs of LGBTQ individuals will allow nurses to provide person-centered, culturallysensitive care.

In June 2016 the ANA membership assembly held a dialogue forum on LGBTQ issues. One of the speakers, a nurse, shared for the first time his

moving story of being in the hospital when his partner experienced a serious health crisis. They were private people, and he described the emotional intensity of the situation that was complicated by having to come out in public for the first time in a hospital waiting room filled with strangers when the nurse called out “Is Mr. Smith’s wife here?” This was one of many powerful stories shared during that session.

Clearly, there is a lot we can do to preserve the dignity of all persons including the LGBTQ community.

Cultural competency focuses on the goal of providing quality care to diverse populations. The pursuit of cultural competence is often based on well-meaning attempts to learn about the basic characteristics of groups — especially health-related norms and customs — the nurse is likely to encounter in practice. In contrast, cultural humility is a personal commitment to a life-long process of learning and self-reflection to explore biases and assumptions. Cultural humility involves relinquishing the role of “expert” and seeking to understand the other’s perspective. In this way we

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can honor individual differences and engage the person as a full partner in a therapeutic relationship.

Healthcare providers’ perception of “otherness” is at the heart of stigmatization and discrimination, a likely contributor to health disparities in the LGBTQ population. LGBTQ youth have more than 3 times the rate of suicide as their peers. Adults are less likely to have a regular source of healthcare and have recommended cancer screenings than their non-LBGTQ counterparts.

Discrimination is especially prevalent in the transgender community.

According to data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS), approximately 0.6% of the US population, about 1.4 million people, identifies as transgender. A survey of 6,436 persons who identified as transgender revealed that 1 in 5 had been refused care because of their transgender status. Over 50% reported postponing medically necessary care for financial reasons or because of prior discrimination by healthcare providers. Nurses can help alleviate healthcare disparities by us-

ing affirming and inclusive language and developing positive therapeutic relationships. Texas ranks second in the nation in the number of people indentifying as transgender, with more than 125,000 individuals.

An important starting place is to recognize the difference between sexual orientation and gender identity: Sexual orientation is a relational concept that encompasses attraction, behavior, and identity and refers to an enduring pattern of or disposition to experience sexual or romantic desires for, and relationships with, people of one’s same sex, the other sex, or both sexes.

Gender identity is defined as a person’s inherent sense of being a girl, woman, or female; a boy, a man, or male; a blend of male or female; or an alternative gender.

Gender expression is the outward appearance of gender through behavior and appearance.

Cisgender is a term used to describe a person whose gender identity is congruent with the sex assigned to them at birth.

Gender nonconforming is a broad term that refers to individuals who do not identify with a binary male/female concept of gender, or who do not conform to the common societal expectations of their gender, or whose gender expression does not fit neatly into a category.

These terms reflect the diversity of human experience.

PRACTICING WITH RESPECT: STORY OF LEE A SMART AND ENERGETIC YOUNG MAN, 17-year-old Lee attends high school in Central Texas, enjoys singing in the choir, and is passionate about filmmaking. And, Lee was born female.

Approximately 1.4 million Americans identify as transgender, an umbrella term for individuals whose gender identity/expression differs from the gender assigned at birth. In Texas 19,600 individuals between 18 and 24 identify as transgender, but the feelings of gender dysphoria can occur as young as five years of age. Just like not all women or men or children or Texans or nurses or any other subgroup of humans are alike, not all transgender individuals have the same needs, desires, or feelings.

As with many issues, differences in approach and opinions occur between generations. One characteristic of transgender youth in Lee’s age group is the use of unique personal pronouns. For example, nurses in Texas who work with the Hispanic community may be familiar with the gender-neutral term “latinx.” Lee prefers the gender-neutral pronouns ve, vis, vim.

Lee recently had a double mastectomy, also known as “top surgery.”

An orchiectomy is referred to as a “bottom surgery” which has an immediate and permanent effect on testosterone levels. These surgeries represent transitions in the deepest

sense of the word: they are major life-changing experiences that will forever mark the start of a new life.

For the remainder of this article, Lee’s preferred pronouns ve, vis, vim will be used.

ONE SIZE DOES NOT FIT ALL Lee was 15 when ve became clear that ve did not identify as female, the gender assigned vim at birth.

A child of the Internet, Lee read everything ve could find about what ve was feeling. It was comforting to discover that options were available and that Lee was not alone.

A common misconception is that transitioning — permanently bringing into alignment the gender a person is assigned at birth with the gender a person identifies with — involves one surgery. Transitioning is a complex process that occurs over time.

Depending on the individual’s preference, age, ability to pay, and reproductive plans, an individual may have none or one or more surgeries.

One of the primary factors in determining which surgeries are appropriate and when they should occur is the individual’s plan for having children. A transgender male (born female transitioning to male) who does not want to give birth to children may choose to have a full hysterectomy at the beginning of his transition. But for someone who isn’t certain about having children, they may want to wait.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), the diagnostic criteria for psychiatric disorders recognized by the U.S. healthcare system, has been updated over the years to reflect changes in thinking on sexuality and gender identity. Homosexuality was listed as an illness until 1973, and conditions pertaining to homosexuality were not entirely removed from the manual until 1987. The most recent update, published in 2013, removes gender identity disorder and replaces it with gender dysphoria. This

Most, but not all, transgender individuals utilize hormones. At this point, Lee chose not to. “For me, it was more urgent to get the top surgery,” said Lee. “I’m happy with the choices I’ve made.”

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After Lee’s surgery, vis mother said, “Lee looks like ve’s supposed to look.”

What better compliment can come from a mom?

EACH PATIENT IS UNIQUE

When asked what nurses could do to improve the care ve received, Lee emphatically said, “Ask what name

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GENDER TRANSITION: ONE NURSE’S STORY

By Ellen Martin, PhD, RN, TNA Director of Practice

GENDER TRANSITIONS involve navigating the fragmented healthcare and legal systems. Given that 0.6% of the population is transgender it follows that about 1,700 of the 284,000 nurses in Texas are transgender. We recently had the opportunity to visit with one nurse who shared her story.

She (her preferred pronoun) began her transition two years ago, and overall her experience was mostly positive.

Well-supported by her family, her coworkers, and her boss, she started with six to eight months of hormone therapy.

The World Professional Association for Transgender Health (WPATH) has practice guidelines and protocols for hormone treatments. Making healthcare decisions, such as whether or when to have surgery, are deeply personal.

Legal issues add a level of complexity.

Changing one’s name is fairly easy.

Changing one’s gender marker is a more complicated process that involves changing the gender on a government document such as a passport then obtaining a court order to amend the birth certificate. The decision on when to change legal documents is also individual. In this case, she wanted to have an updated driver’s license prior to taking a long road trip. Having a different appearance than the gender noted on the driver’s license can be an issue of personal safety. Things can get even more complicated when the individual is a licensed professional.

Updating one’s nursing license is a straightforward procedure. Nurses have 10 days to change their name with the Board of Nursing. The nurse provides the Texas Board of Nursing

with the supporting court documents to update the license record to reflect the new name and gender marker. As a case manager with a caseload of long-term clients, she and her employer had planned to notify patients over time after her transition was complete.

In an effort to make sure all the “i’s were dotted and t’s were crossed” she spoke with a BON staff member about her situation and shared the plan. The staff member she spoke with insisted that all her patients must be informed within 30 days, emphasizing that the nurse’s practice is built on trust. The nurse tried to explain that patients don’t have the right to know about a nurse’s personal life such as a name change from a divorce. In addition, gender transitions may take longer than 30 days depending on hormonal effects, and it is difficult (if not impossible) to perfectly time changes in personal appearance with the legal name change and license change.

Despite the nurse’s efforts, the BON staff member stood by the opinion, stating that this change was different because of the physical change in appearance, citing the “patient’s right to know.” The staff member emphasized the potential consequences of actions against a licensee if the name on the name badge did not match the nurse’s legal name on file. While the information from the staff member was appreciated, it was disheartening that the staff member interjected her personal opinions into the situation. Not wanting to make the situation worse, the nurse did not further question the staff member or ask to speak to a supervisor.

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There are no provisions in the Nurse Practice Act or board rules requiring transgender nurses to notify clients.

Kristin Benton, MSN, RN, Director of Nursing at the BON emphasized that the BON expects staff to treat everyone with respect and encourages nurses who do not feel they are getting accurate or complete information to speak to a supervisor.

To protect her license, the nurse spoke to her employer, and they agreed that the safest plan was to push up the notification plan. This short notification window put an unexpected burden on the nurse’s workload and affected her employer and coworkers. It was an awkward situation not only because it is deeply personal but because the plan had been to notify clients after her transition was complete, not before.

She was able to notify over 140 clients within 30 days and most were very supportive. Only a handful responded that they were “too old-fashioned” or felt uncomfortable and asked to change case managers. However, this rapid time frame also created a boundary issue for patients who expressed support of her transition and were curious “how the transition was going.” This was the reason why they had originally planned to wait to notify patients.

Because nursing encounters are supposed to be about the patients and not the nurse, she ultimately decided to transfer to a new role.

Reflecting on her experience, the nurse noted that this a good time to be transgender with increased visibility and advocacy. She is also working to continued on page 23

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TEX AS NURS ES AS SOCIATION

PRACTICING WITH RESPECT: STORY OF LEE continued from page 7

and pronouns I use!”

While Lee’s surgeon and nursing staff were quite competent, they repeatedly called vim by the wrong pronoun and by the name given to vim at birth, which ve no longer uses and does not identify with. For many transgender individuals, being called by the name associated with the gender assigned to them at birth is very hurtful.

Consider, a 17-year-old undergoes a double mastectomy, and the worst part of the experience is that the nursing staff did not use the preferred name and pronouns. This highlights the importance of respecting personal gender identity, especially for those who have struggled to bring the gender assigned at birth into agreement with their gender identity. It additionally com-

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Although significant challenges still occur, transgender individuals attending high school even 10 years ago and certainly 20 or 30 years ago, had a very different experience than those today.

While students of the past would likely try to hide their struggle, today, the conversation has moved into the public realm.

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Most nurses became nurses because they felt called to it and truly care about their patients. And, most nurses are busy and may have numerous patients. In the provision above, ANA asserts that fundamental to the practice of nursing is treating each person as a unique individual. Asking for and honoring a patient’s preferred pronouns and name is one of the most basic ways to follow this provision of the Code of Ethics.

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According to the American Nurses Association (ANA) Code of Ethics for Nurses, Provision 1: The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.

It may seem awkward or intrusive at first. From the patient’s perspective, it’s not, and it communicates respect. And, you may mess up; that’s ok. Just correct yourself, apologize, and move on.

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municates how something that some might consider “minor” has the ability to thoroughly and negatively impact the patient’s experience.

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At Lee’s school, roughly 10 kids are transgender. While the faculty is somewhat supportive, those students all share a 1-person bathroom to change for gym and use the bathroom. Not an adequate or appropriate solution.

The Supreme Court has recently accepted Gloucester County School Board v. G.G. The result, expected next year, will determine if transgender students have the right to use the bath-

CENTER NURSE EXECUTIVE/ DIRECTOR OF NURSING room that corresponds to their gender identity.

The plaintiff, Gavin Grimm, is a 17-yearold transgender teen in Virginia. After he (his preferred pronoun) came out as a transgender male during his freshman year, he was allowed to use the boys’ bathroom until some parents complained. The school then required students to use the bathroom matching the gender assigned them at birth or a one-stall bathroom in the nurse’s office.

Grimm sued the school board.

In May, President Barack Obama directed all schools to allow students to use the bathroom that matches their gender identities. The White House asserts that not allowing students to use the bathroom of the gender they identify with violates Title IX, a federal law that protects students from gender discrimination. U.S. District Judge Reed O’Connor later signed an injunction to allow schools to disregard President Obama’s directive.

The Supreme Court is expected to issue their decision next year. The Court’s judgment on the constitutionality of bathroom laws will be a historical marker, and for Lee and thousands of students like vim across the country, will have a significant impact on vis young adulthood.

NURSES CAN LEAD THE WAY

As nurses, you’ve always put your patients first. While remembering to ask about names and pronouns may seem difficult and unnecessary, this one gesture can make a huge difference in the experience of your patient.

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TNA POLICY COUNCIL CONCLUDES REVIEW OF 2017 POLICY POSITIONS

By Andrew Cates, TNA General Counsel and Director of Government Affairs

IN LATE 2015, the Texas Nurses Association’s (TNA) first Policy Council was convened to identify those issues most important to Texas nurses. Working through committees, the Council investigated, debated, and evaluated the issues, creating positions that were then brought before the TNA Board for approval.

In the newly published 2016-2017 Public Policy Positions, TNA outlined each topic with the background, legislative history, and TNA’s position. To download a PDF of the policy book, please visit TNA’s website at texasnurses.org. Below is an overview of TNA’s positions.

Education Loan Repayment Program (PELRP) funding for the Nursing Faculty Loan Repayment Program. Only with a dedicated funding source will the program be able to reliably incentivize nurses to become faculty and assist in the nursing shortage reduction efforts.

MENTAL HEALTH Safe Workplace: TNA believes that two immediate strategies will promote a safer workplace for nurses working in mental health:

Provide nurses employed in all mental health hospitals the same weapons-free work environment already afforded to nurses in licensed hospitals.

Evaluate the feasibility of creating a statewide reporting system for staff injuries in all mental health facilities.

APRN ISSUES TNA supports full practice authority for APRNs in all four roles without burdensome government restrictions and anti-competitive supervision by another profession. TNA additionally urges the Legislature to consolidate all regulatory authority of nurses, including APRNs, under the Board of Nursing (BON).

NURSING EDUCATION In the 84th legislative session, $33.75 million was appropriated to the Professional Nursing Shortage Reduction Program (PNSRP). TNA urges the legislature to continue its commitment to Texas citizens by reinvesting in the PNSRP in its 85th session.

TNA recommends that the legislature set aside a portion of the Physician

Access to Inpatient Care: TNA supports changes to the Mental Health Code that will facilitate civil commitment of individuals judged to be a danger to self or others. Individuals should not have to severely decompensate or commit a crime to access an inpatient bed. Efforts to ensure that services are provided in the most appropriate setting should also be a priority.

Mental Health Funding: TNA supports program funding to:

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Reduce the nursing shortage in Texas.

PAGE 12

Provide community-based mental health services to decrease wait lists and unnecessary referrals.

Increase Medicaid reimbursement rates for mental health providers.

Establish mutually-funded partnerships with the Veteran’s Administration to provide community support, including the Veteran Services Provider Network (VSPN) and programs offered through TexVet.

Texas Peer Assistance Program for Nurses: TNA recommends maintaining the current appropriations process through the Board of Nursing to continue the important services offered

by TPAPN to Texas nurses.

REGULATORY ISSUES Nurse Licensure Compact (NLC)/Telehealth: Texas should adopt the new NLC to avoid unnecessary barriers to

WORKPLACE ISSUES

practice. New market participants lower costs and increase access to care.

APRN Issues: The Board of Nursing must have sole regulatory authority over APRNs in Texas. The Sunset bill in the 85th legislative session should incorporate this concept to reduce duplication of state resources and anti-competitive practices.

Board of Nursing Just Culture: TNA supports the “Just Culture” approach to disciplinary action which suggests that contextual factors must be considered when evaluating nursing errors.

Excelsior College: The Texas Legislature should sunset the grandfather clause that allows Excelsior College, an out-of-state online program, to operate without adhering to nursing education standards in Texas.

Workplace Violence: TNA believes that there are opportunities to improve workplace safety for nurses and other health care workers. HB 2696 (2015) authorized a statewide study to gather Texas specific data regarding the existence of workplace violence and current strategies being implemented to mitigate these events. Resultant data will assist Texas to develop state specific strategies to prevent workplace violence, protect our health care workforce, and provide safe environments for patients.

Fatigue: TNA believes nurses and employers must collaborate to reduce the risks of nurse fatigue associated with shift work and long hours. Employers should utilize their staffing committees to ensure practices are sensitive to risks to patient care related to nurse fatigue.

Safe Staffing: TNA believes that the best patient care is achieved when nurses are empowered to influence their practice environment. The existing Hospital Safe Staffing Law (2009) requires hospitals to employ staffing committees to enable nurses to influence staffing levels. TNA continues to advocate for full implementation of existing statute which requires hospital employers to utilize nurse staffing committees to develop staffing plans and report this work to their Board of Directors.

For questions on the above positions or for additional information, please contact TNA General Counsel and Director of Government Affairs Andrew Cates at acates@texasnurses.org. i

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SO YOU WANT TO BE AN APPROVED PROVIDER?

By Laura Lerma, MSN, RN, TNA CNE Manager

JANUARY AND JULY are busy times for your TNA ANCC (American Nurses Credentialing Center) Accredited Approver Unit. It is in January and July that we accept Approved Provider applications.

Approved Provider Units are entities that have established the systems, processes, and infrastructure to develop, implement, and evaluate continuing nursing education (CNE) activities.

Because TNA is accredited by ANCC, those Provider Units approved by TNA are able to award nationally-recognized contact hours without those activities needing to come to TNA first for review and approval. Currently, under the TNA umbrella, there are 136 Approved Provider Units.

The journey to become an Approved Provider starts with submitting to TNA three individual activity applications for review and approval of three separate educational events. These activity applications must meet both ANCC/ TNA and Texas Board of Nursing criteria as they pertain to CNE. The activity applications are reviewed by members of the TNA CNE Committee, also known as CNE Nurse Peer Reviewers. The CNE Nurse Peer Reviewers work with the activity’s Nurse Planner — an RN with a baccalaureate or higher degree in nursing who is responsible and accountable for the overall activity and the activity application — to ensure that both the activity and the activity application meet criteria. Once the

three activity applications have been approved, the entity becomes eligible to apply for Approved Provider status.

The awarding of Approved Provider status is the means whereby TNA grants public recognition to an Approved Provider Unit that has met the established standards for providing CNE activities. As mentioned earlier, Approved Provider applications are accepted in January and July. These applications are also reviewed by members of the TNA CNE Committee — Nurse Peer Reviewers — for compliance with ANCC/TNA criteria.

The Nurse Peer Reviewers work with the Approved Provider Unit’s Primary Nurse Planner to ensure that the infrastructure is in place to support the development and implementation of CNE activities.

WHEN WRITING AN APPROVED PROVIDER APPLICATION: Make sure to review the application guidelines. The guidelines provide details and questions that will help in addressing the criterion.

Plan ahead. Start pulling together the data and examples needed to complete the application well before the due date. The Approved Provider application is not only the documentation that needs to be submitted as part of the approval process but it also serves as the Approved Provider Unit’s policy and procedure manual. It should be reviewed by members of the continued on page 23

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TNA-Approved Providers of CNE (as of October 2016) APIC Houston 006*

Juanda’s Consulting Company

St. Joseph Medical Center

Alamo Colleges

Kelsey-Seybold Clinic

Amarillo College Center for Continuing Healthcare Education*

Kingwood Medical Center

Tarleton State University Nursing Professional Development

Lamar University Dishman School of Nursing*

Terri Goodman and Associates*

Ames High

Las Palmas Del Sol Healthcare System

Baptist Health System*

LeadingAge Texas

Texas A&M Health Science Center College of Nursing*

Baptist Hospitals of Southeast Texas

MJS and Associates, LLC

Baylor University – Louise Herrington School of Nursing

McLennan Community College

BorderRAC Careflite Cedar Park Regional Medical Center Central Texas Veterans Healthcare System CHI St. Joseph Regional Health Center CHI St. Luke’s Health Baylor St. Luke’s Medical Center CHI St. Luke’s Health Patients Medical Center CHI St. Luke’s Health – The Woodlands Hospital Children’s Health* CHRISTUS Hospital Education Resource Center CHRISTUS Santa Rosa Health System

Medical Center Hospital Medical Center of Arlington

Texas A&M University - Corpus Christi College of Nursing and Health Sciences (TAMU-CC CONHS) Texas Association for Healthcare Quality

Medical Center of McKinney

Texas Association for Home Care & Hospice

The Medical Center of Plano*

Texas Children’s Hospital

The Medical Center of Southeast Texas

Texas Christian University – Harris College of Nursing and Health Sciences

Medical City Dallas Hospital

Memorial Hermann Health System*

Texas Department of Aging and Disability Services – Regulatory Services Division*

Memorial Hermann – Texas Medical Center

Texas EMS, Trauma & Acute Care Foundation

Memorial Hermann Southeast Hospital*

Texas Health Dallas - Texas Health Resources University

Medical Eagle Forensic Nurse Consultants, PLCC

The Menninger Clinicv

CHRISTUS Spohn Health System

Methodist Healthcare Ministries of South Texas, Inc.*

CHRISTUS St. Michael Health System*

Methodist Health System

CHRISTUS Trinity Mother Frances Health System*

Metroplex Healh System

Texas Health Fort Worth Center for Advancing Professional Practice Texas Health Huguley Fort Worth South* Texas Health Resources University Texas and New Mexico Hospice Organization

Citizens Medical Center

Michael E. DeBakey Veterans Affairs Medical Center

Clear Lake Regional Medical Center

Midland Memorial Hospital

Texoma Medical Center

Community Hospice of Texas

Midwestern State University

The Hospitals of Providence

Conroe Regional Medical Center

mmLearn.org at Morningside Ministries*

TRS Behavioral Health Inc.

Cook Children’s Medical Center*

Nexus Health Systems

UT Harris County Psychiatric Center

Corpus Christi Medical Center

North Hills Hospital

UT Southwestern University Hospitals

Covenant Health

Northwest Texas Healthcare System*

United Regional Health Care System*

Dallas Medical Center

Universal Health Services

Del Mar College

Nursing Faculty Development Program, South Texas College

Denton Regional Medical Center

Odessa Regional Hospital

University Medical Center of El Paso*

DeTar Healthcare System

Oklahoma Nurses Association

University Medical Center–Lubbock

Doctors Hospital at Renaissance

Park Plaza Hospital

University of Texas Health Center At Tyler

Driscoll Children’s Hospital

Parkland Health & Hospital System Department of Nursing Education

University of Texas Health Science Center At Houston School of Nursing

Peterson Regional Medical Center

University of Texas MD Anderson Cancer Center*

East Texas Medical Center Regional Healthcare System El Paso Children’s Hospital

Plaza Medical Center of Fort Worth

Foundation Management Services, Inc

Providence Healthcare Network

Golden Plains Community Hospital

Rio Grande Regional Hospital

Good Shepherd Medical Center

San Angelo Community Medical Center

Green Oaks Hospital

Selman-Holman & Associates, LLC

H.I.S. Cornerstone

Seton Healthcare Family

Harris Health System

Shannon Medical Center

HealthCare ConsultLink

Shriners Hospitals for Children – Galveston

Hendrick Medical Center

South Texas Health System

Hospice Austin

South Texas Veterans Health Care System Learning Center

Houston Community College Houston Independent School District Houston Methodist JPS Health Network

Southwest Texas Regional Advisory Council for Trauma (STRAC Continuing Education Committee) St. David’s Institute for Learning

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Texas Scottish Rite Hospital for Children

University Health System

University of Texas Medical Branch Continuing Nursing Education University of the Incarnate Word, Ila Faye Miller School of Nursing and Health Professions UNT Health Science Center Val Verde Regional Medical Center Valley Regional Medical Center Veterans Affairs North Texas Health Care System Visiting Nurse Association of Texas Wadley Regional Medical Center* The Woman’s Hospital of Texas i *Approved with Commendation

LET’S GET CONNECTED New TNA Online Member Community

By Belinda Richey, TNA Staff

IN OCTOBER, the Texas Nurses Association online member community was upgraded, and we think you will love it!

TNA members can expect a brand new way to easily connect with nursing colleagues, share information and photos across the TNA network, and manage member preferences. Finding member information and updates will be easier than ever thanks to this exciting new enhancement.

When visiting texasnurses.org either from your desktop or your mobile device, log in using your TNA member username/password or your facebook login credentials, and click on Groups in the right-hand navigation box.

Members will be auto-assigned to their geographical TNA district and to any TNA committees or councils they’ve been appointed to. In addition, several expert advisory panels are open to every member — just click on Join beside the group and you can begin connecting with other members interested in the same group topic. If you want to see all the activities from all your groups in one message feed, it is simple to do — just visit each group at least once and make a comment or like another user’s comment.

TNA members can expect a brand new way to easily connect with nursing colleagues, share information and photos across the TNA network. . . which is a quick way to keep TNA and ANA apprised of any changes you need to make to your member record.

Start connecting today and let us know how you like the new features. If you experience any problems please contact Francis Saenz, Member Specialist at fsaenz@ texasnurses.org. i

One really great feature of the new community is you can manage your member profile directly from the community,

PAGE 17

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2017 NURSE DAY AT THE CAPITOL: MAKE YOUR VOICE HEARD Feb. 27 – 28, 2017

By Catherine White, TNA Staff

BE THE CHANGE you wish to see in the Texas nursing profession!

MARK YOUR CALENDAR Mark your calendar for TNA’s 2017 Nurse Day at the Capitol, scheduled for Monday, Feb. 27 and Tuesday, Feb. 28, 2017, to join nurses from throughout Texas to make your voice heard at the Texas Capitol in Austin.

Whether providing quality healthcare to underserved populations in Texas is important to you, or you want to ensure that there is enough funding in the state budget to support nursing education, TNA’s Nurse Day at the Capitol will provide you the opportunity to learn about the issues and to showcase your advocacy skills. With almost 300,000 registered nurses in Texas, TNA’s Nurse Day at the Capitol gives each of you the information and support to spend the day educating and engaging state legislators on these and other essential issues to nursing.

moment illuminated the influence of the nursing profession across the country and demonstrated how powerful nurses can be when they join together.

Erin McCracken, BSN, RN2, CEN, of Dallas, attended Nurse Day at the Capitol in 2013.

“In the 2013 Nurse Day at the Capitol I learned that progress towards advancing our profession is us all acting as change agents with the same shared voice and vision,” Burley says.

“I still remember that day and bring up my experiences to coworkers often,” she says. “I particularly remember speaking to a representative with a group of nurses — some had been nurses for years, some, like me, were just entering the field — about felony charges for violence against nurses/ providers in the ER. Throughout my career as an ER nurse I have seen multiple patients arrested after treatment for assault. The experience taught me that when nurses come together, like on Nurse Day, we are loud, and people listen.

“Nurse Day made me feel like I helped make a change, a change that keeps nurses safe all over the state of Texas,” McCracken continues.

In September 2015, the moderators of “The View” on ABC found out just how influential nurses were in America when they joked about the profession and were quickly inundated with supporters expressing deep respect and admiration for nurses and the jobs they perform. That pop culture

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Nurse Day at the Capitol offers a vital opportunity for Texas nurses to unite in a mighty display of solidarity and to capitalize on the public’s positive view of the profession.

El Burley, BSN, RN, of Pflugerville, who plans to attend 2017 Nurse Day at the Capitol, has been going since 2013 when she was in nursing school.

“Nurse Day at the Capitol is incredibly important — there are 3 million nurses nationally and 300,000 nurses in Texas.

We are a large group and should have a correspondingly strong voice. We must work together to have a cohesive message, and events like Nurse Day at the Capitol are pivotal in sending a clear message to those who have political influence and power,” she explains.

2017 NURSE DAY AT THE CAPITOL ACTIVITIES On Monday, Feb. 27, nurses will convene at Embassy Suites, 5901 N. IH-35 in Austin at 1 p.m. for a greeting from legislators who support nursing, followed by presentations on how to navigate the legislature as well as information about nursing’s 2017 legislative agenda that you can share with your legislator and their staff on Tuesday.

Monday’s events also include a TEXAS NURSE PAC fundraiser

PAGE 18

ERIN MCCRACKEN, BSN, RN2, CEN, of Dallas, attended 2013 Nurse Day at the Capitol and made a connection that led to her dream job.

“Nurse Day is a great way to network and meet nurses from all over the state. I was a nursing student and really only wanted one job. I wanted to be a Parkland Emergency Room Nurse. I hadn’t turned in my application but I knew that’s the only job I truly wanted. At Nurses Day I spotted a Parkland jacket and Dr. Z. [Zolnierek] encouraged me to go and speak to her. I introduced myself and confessed my interest in becoming an ER nurse. The woman in the jacket was Jorie Klien, Director of Trauma and Disaster at Parkland Hospital! We exchanged numbers. Jorie gave me excellent interview advice and turned in my resume. Here I am, an ER nurse, 3 years later and I know Jorie is always willing to give me advice. I wasn’t expecting to find my dream job or a mentor at Nurses Day, but what a blessing it was!”

EL BURLEY, BSN, RN, of Pflugerville, is the TNA District 5 President-elect. She began attending Nurse Day at the Capitol in 2013 when she was in nursing school.

“In the beginning (2013) I thought it would be great to get involved in the nursing profession in advance of graduation and passing the NCLEX; a sense of camaraderie with my future fellow colleagues. Now I feel as if it is a fiduciary responsibility to be present, active, and share the voice of nursing with my representatives, both state and national. In the 2013 Nurse Day at the Capital I learned that progress towards advancing our profession is us all acting as change agents with the same shared voice and vision.

I am so very thankful for [TNA Executive Director] Cindy Zolnierek and St. David’s School of Nursing at Texas State University for instilling in me and my fellow graduates the necessity to be an active participant rather than a bystander in the political process and the progression of nursing as a valued profession. “

to raise money to assist legislators that fight for nursing issues throughout the Legislature and interim sessions.

On Tuesday, nurses head to the Capitol in downtown Austin for scheduled meetings with their state legislators and staff to discuss issues important to nursing as well as, hopefully, establishing a relationship so that nurses can assist their lawmakers in making future decisions that may impact nursing and healthcare in Texas. Nurses will also be able to observe the Legislature in action as legislators conduct committee meetings and other business.

“Without coordinated efforts such as Nurse Day at the Capitol, it would be much more difficult to have a systematic approach to political efforts and progression of nursing,” says Burley.

Join the chorus of voices at the Capitol on Feb. 27 and 28, 2017, and show state lawmakers how strong the nursing workforce is in Texas.

REGISTRATION IS NOW OPEN The cost to attend 2017 Nurse Day at the Capitol is $50 for TNA members and prelicensure students (students must be in enrolled in one of their last two semesters of school and must be accompanied by a faculty member). The cost is $75 for non-TNA members. Prices do not include individual costs for hotel rooms.

The TEXAS NURSE PAC fundraiser is open to TNA members and affiliates of the Nursing Legislative Agenda Coalition (NLAC) only. The cost to attend the TEXAS NURSE PAC fundraiser is $50.

Visit TNA’s website at texasnurses.org for event information and to register. If you have any questions, please call 1-800862-2022, ext. 136 or email Catherine White at cwhite@ texasnurses.org.i

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A UNIFIED VOICE TO ADVANCE NURSING

By Cindy Zolnierek, PhD, RN, TNA Executive Director

suggesting that allowing APRNs to practice to the full extent of their education and training would address the delays in care experienced by Veterans (November 2015). In February 2016, the Alliance hosted almost 300 RNs and APRNs at an APRN Legislative Day at the Bullock Museum.

Most recently, the Alliance coordinated a campaign to support VA proposed rules to bring its policies in line with the Department of Defense and eliminate burdensome restrictions on APRN practice. Additionally, the Alliance provided a joint letter of support for these proposed rules.

THE APRN ALLIANCE is a partnership of organizations that seeks to advance common interests with a unified voice.

As an informal collaborative, our focus is improving the practice environment for APRNs in Texas. All participating organizations are equal partners.

Launched in the fall of 2015, the APRN Alliance includes the:

Consortium of Texas Certified Nurse-Midwives,

Texas Association of Nurse Anesthetists,

Texas Clinical Nurse Specialists,

Texas Nurse Practitioners, and

Texas Nurses Association.

Staff and officers of partner associations meet regularly to share information, identify opportunities, and develop future plans.

Actions to date include a joint communication to Governor Greg Abbott

Leading up to the 85th Texas Legislative Session, the Alliance is actively strategizing for success. The Alliance crafted consistent messaging to the Sunset Commission around APRN practice authority and regulation.

Alliance partners are visiting face to face with legislators and educating staff about the four APRN roles [bit. ly/2fwF832]. Additionally, association staff are engaging stakeholder support for reducing barriers to practice.

While many groups have verbalized support, the Texas Public Policy Foundation, Texas Chapter of AARP, and the Texas Association of Business have committed support for full practice authority.

By combining our individual efforts and coordinating our unique strengths, the APRN Alliance is creating synergy sure to enhance our effectiveness in the policy arena. How can you help?

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PAGE 20

ENCOURAGE COLLEAGUES TO JOIN TNA There is power in numbers. Approximately 70 percent of the 63,000 Texas physicians belong to the Texas Medical Association. While nurses outnumber physicians by almost 500 percent, nurse membership in TNA pales in comparison to TMA. Imagine the power nurses could harness by uniting!

CONTRIBUTE TO TEXAS NURSE PAC The reality in Texas is that legislators need funds to be elected and run for re-election. Through TEXAS NURSE PAC, nurses can make their voices heard on our issues and invest in the future of the nursing profession at the same time. We have a lot of ground to make up, as TMA’s PAC has a minimum of $1 million dollars available for candidate contributions at any given time. Yet, our strength is in numbers! If EVERY nurse gave $10, we could compete at a high level and elect legislators who support nursing.

MAKE YOUR VOICE HEARD! Sign up for legislative alerts and calls for action so you can contribute to our progress through the legislative session. Contact Andrew Cates at ACates@texasnurses.org. i

2017 MARK YOUR CALENDARS 2017 Features the TNA Events You Love!

Room Rates: $159 single/double Registration: $400 TNA Members/$350 TNA Member Students*; $500 Nonmembers; $450 Nonmember Students* (*Students are RN-to-BSN, Master, or Doctoral ONLY)

NURSE DAY AT THE CAPITOL FEB. 27 – 28, 2017

Texas State Capitol See page 16 for more information.

Event Registration available April 1, 2017, at texasnurses.org.

HOUSE OF DELEGATES

Both the TNA House of Delegates and Leadership Conference are being held at the newly constructed Sheraton Hotel and Conference Center in beautiful historic Georgetown (1101 Woodlawn Ave., Georgetown, TX 78628). Call 737-444-2700; Mention TNA when making reservations.

APRIL 28 – 29, 2017

*Texas Nurses Association/Foundation Provider Unit is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Sheraton Georgetown Texas Hotel and Conference Center Again this year you can expect an engaging experience to inform TNA’s future!

Room Rates: $149 single/double Registration: $60 Delegates; $100 Observers Event registration available Feb. 1, 2017, at texasnurses.org.

Protect Your License!!

If you have received: Letter of Investigation from the Texas Board of Nursing Notice of Peer Review

LEADERSHIP CONFERENCE* SEPT. 28 – 29, 2017 Sheraton Georgetown Texas Hotel and Conference Center In addition to a recap of the legislative session from various perspectives (TNA, THA, and BON) as well as an update from the Center for Nursing Workforce Studies, we will explore relational competence by analyzing creative work and welcoming special guest presenters:

Bonnie Wesorick, RN, MSN, DPNAP, FAAN (gvsu.edu/wesorick/)

Margaret J. Wheatley (margaretwheatley.com/)

Call today, delay is not an option!

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PRESIDENT’S COLUMN We are not called to be popular, We are not called to be safe, We are not called to follow, We are the ones called to take risks.

We are the ones called to change attitudes, to risk displeasures.

We are the ones called to gamble our lives for a better world.

Calls for nominations have already or will soon be sent for participation at the district and state level. Each of us who holds membership in TNA is a link in the chain that supports our shared mission. Using the strength of your link in the chain, how will you help ensure that TNA continues to be a strong voice for nurses in the state of Texas?

Will it be within your district? Will it be at the state level? Wherever you seek to serve, please know your commitment is highly valued.

Thanks for taking a few minutes out of your day to consider my request. Now, if you believe like I do, let’s get to work gambling our lives to create that better world.

CULTURAL HUMILITY

REFERENCES

Tervalon, M., & Murray-García, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117-125.

continued from page 4

continued from page 7

important move reflects the distress that a person may experience if there is a “marked incongruence between one’s experienced/expressed gender and assigned gender.” These important updates mark the change from seeing LGBTQ individuals as “disordered,” an important step in helping to remove stigma. i

GENDER TRANSITION continued from page 8

use her experience to improve care for others.

“Transgender is who we are, not a problem on a problem list,” she said.

“It’s a consideration.”

The nurse is currently working with her

Agency for Healthcare Research and Quality (2012).National Healthcare Disparities Report, 2011. Retrieved online: archive.ahrq.gov/ research/findings/nhqrdr/nhdr11/nhdr11.pdf Flores, A.R., Herman, J.L., Gates, G.J., & Brown, T.N.T. (2016). How many adults identify as transgender in the United States? Los Angeles, CA: The Williams Institute Institute of Medicine (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: The National Academies Press.

organization and electronic health record vendor to make changes to support better care for transgender patients. For example, one of the barriers to patient-centered care is that electronic health records are not designed to capture preferred pronouns.

She is also working to ensure that guidelines and protocols for transgender patients are incorporated into the

Peace, Jeff EDITOR’S NOTE: To find out more about the TNA offices available for candidacy this year, please visit texasnurses.org.i

The Joint Commission (2011). Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community: A Field Guide. Oak Brook, IL: The Joint Commission.

Retrieved online: jointcommission.org/lgbt/ Human Rights Campaign: hrc.org

software and clinical practice.

A fundamental aspect of nursing is treating patients, colleagues, families, and students with respect. That should not occur as a burden, but rather as a gift — a gift that you are able to share as a nurse. i

SO YOU WANT TO BE AN APPROVED PROVIDER? continued from page 15

Approved Provider Unit periodically.

Each Approved Provider Unit must establish quality outcome measures related specifically to their Approved Provider Unit and nursing professional development that they must monitor on

an ongoing basis. A process for gathering, recording, and evaluating the data must be established and maintained.

Attending an Approved Provider Workshop is highly recommended. The Workshop provides valuable information and

PAGE 23

an opportunity to ask questions.

If you have questions about how to become an Approved Provider, please contact the CNE Program Manager, Laura Lerma at llerma@ texasnurses.org. i

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8501 North MoPac Expressway Suite 400 Austin, TX 78759-8396

TNA DISTRICT LEADERS GATHER FOR SHARED WISDOM

By Cindy Zolnierek, PhD, RN, TNA Executive Director

What lies behind us and what lies before us are tiny matters compared to what lies within us.

— Ralph Waldo Emerson TNA WELCOMED District leadership to a fall forum on Sept. 24. With 14 districts attending, the meeting began with an over the shoulder view: In 2013 TNA engaged in a pricing pilot with ANA, reducing membership dues from over $300 to $174. This pricing adjustment contributed to more than 100 percent growth in membership.

The 2013 House of Delegates (HOD) directed TNA to implement a new structure. This directive was revised by the HOD in 2014, and TNA embarked on an organizational renewal to position the association for future success through membership engagement. New members want to engage and be connected, and an active membership contributes to TNA’s long term success.

TNA’s organizational renewal effort culminated in a plan approved by the Board and HOD in 2015. In the summer of 2015, the fruit of that renewal effort became TNA’s strategic plan. (See sidebar) Consistent with the TNA Plan for Renewal, the TNA strategic plan has an emphasis on the importance of districts engaging members locally, particularly new members. In fact, the plan for renewal and the current strategic plan are predicated on the power of local engagement. The

most vibrant districts — regardless of size — employ avenues to welcome newcomers, frequently rotate board leadership, and mentor new association leaders.

TNA has provided tools to districts to assist in local engagement efforts.

These are located on the TNA website in the District Resource Center.

Explore, and see what is there!

To retain active district status, all TNA districts are required to implement certain activities, such as the Faculty/ Student Engagement Toolkit and Advocacy/Grassroots Toolkit.

A toolkit on Nursing Salons is also available to assist districts in recreating the Salon facilitated by Marie Manthey at the last HOD. TNA is a lead participant in Beta testing of ANA’s Healthy Nurse Healthy Nation initiative — the goal of which is to promote the nation’s health by engaging the more than three million American nurses in healthy behaviors that can impact overall national health.

The Texas Nurses Foundation has invested in a project, My Gift of Grace (MGOG), to facilitate conversations around end-of-life wishes. Toolkits are available for districts interested in host-

TNA’S STRATEGIC GOALS 1. Strengthen districts through enhanced services and accountability 2. Aggressively grow membership by acquiring, engaging, and retaining members 3. Advance the quality and safety of patient care through policy initiatives that optimize professional nursing practice, advance positive nursing practice environments, and promote full use of the knowledge and skills of nurses.

4. Exploit opportunities to maximize financial value to TNA; develop/analyze (ROI) business plans for additional revenue sources that align with the mission and vision of TNA.

ing conversations in their communities.

(A webinar regarding MGOG will be provided by TNA).

Attendees enjoyed participating in the MGOG activity.

“The training for Texas nurses was extremely enlightening,” said Daria Close, MSN, RN, of District 11. “It was a great experience to spend time with nurses from all around the state.”

The future is ours! Great things lie “within us.” We hope the resources provided will support districts to accomplish great things. i