texa s nu r s e s .o rg
TEXASNURSING M A G A Z I N E A day in the life of ...
Unique Experiences from Spirited Nurses Across Texas
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 | FA L L 2 0 1 9
FALL 2019 Volume 93, Number 3 EDITOR IN CHIEF: Cindy Zolnierek, PhD, RN, CAE MANAGING EDITOR: Kanaka Sathasivan, MPH 4807 Spicewood Springs Rd., Bldg 3, Suite 100, Austin, TX 78759-8444 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, NEA-BC, President Tamara “Tammy” Eades, DNP, MSN, RN, President-Elect Amy McCarthy, MSN, RNC-MNN, NE-BC, Secretary Gayle Dasher, RN, PhD, ANP-BC, Treasurer DIRECTORS: Tina Cuellar, PhD, RN, PMHCNS-BC Melinda Hester, DNP, RN Donna Wallis, MBA, MSN, RN Patricia Freier, MSN, RN-BC, RCIS Shakyryn Napier, DHSc, MSN, RN, CPN
TNA DISTRICT AND PRESIDENT Dist.1:
VISION Nurses transforming health TEXAS NURSING (ISSN 0095-36X) is published quarterly— Winter, Spring, Summer, Fall—by the Texas Nurses Association, 4807 Spicewood Springs Rd., Bldg 3, Suite 100, Austin, TX 78759-8444 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. PUBLISHING PARTNER Monarch Media & Consulting, Inc. P: 512.680.3989 or 512.293.9277; F: 866.328.7199 monarchmediainc.com | chellie@monarchmediainc.com Advertising inquiries: call Chellie Thompson at 512.293.9277. TEXAS NURSING is indexed in The Cumulative Index to Nursing and Allied Health Literature and in the International Nursing Index. 16mm, 35mm microfilm, 105mm microfiche, article copies available from University Microfilms International: 1.800.521.3044 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.
Dist. 4: Natalie D. Garry, 214.648.7204, Ngarry1617@gmail.com, Secretary: Sahar Seyedkalal, Sahar.Seyedkalal@phhs.org, https://tnad4.nursingnetwork.com Dist. 5: Leah May, 512.989.9344, leahmay2108@gmail.com Dist. 7: Stacy Cooper, 325.236.3488 ext. 3488, staycoop@yahoo.com, District office: P.O. Box 1482, Belton, TX 76513, tnadistrict7@gmail.com Dist. 8: Sarah J. Williams, 210.679.7237, sarah.williams1947@outlook.com Dist. 9: Juliana Brixey, jjbrixey@hotmail.com, District office: Melanie Truong, 7324 Southwest Freeway, Suite 2-1453, Houston, TX 77074; 713.523.3619; tna9@tnadistrict9.com; tnadistrict9.com Dist. 11: Linda Treitler, linda.treitler@mwsu.edu Dist. 17: Mari Cuellar, 361.362.7016, mgrace2329@yahoo.com Dist. 18: Janice L. Miller, 806.775.8968, janice.miller@umchealthsystem.com Dist. 19: Anita Lowe, 903.445.9626, alowe@uttyler.edu, Secretary: Mikayle Durant, 903.721.1388, mikidurant@live.com Dist. 35: Chrystal Brown, 903.434.8302, cbrown@ntcc.edu At-large: Contact TNA, 800.862.2022, ext. 129, brichey@texasnurses.org
POSTMASTER Send address changes to TEXAS NURSING, 4807 Spicewood Springs Rd., Bldg 3, Suite 100, Austin, TX 78759-8444 ARE YOU MOVING? Need to change your address? If so, provide it quickly and easily in the Members Only section of the TNA website, texasnurses.org. Or mail 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 2019 © Texas Nurses Association
T E X A S N U R S I N G M AGA Z I N E | FA L L 2 019
Clarissa Silva, clarissa2277@att.net, clarissa.silva@ttuhsc.edu
Dist. 3: Margie Dorman-O'Donnell, margie.dormanodonnell@cookchildrens.org, District Staff: Jamie Rivera, jamiegilbert@texashealth.org
PAGE 2
RESPONDING TO A CRISIS BRINGING CARE TO RURAL PATIENTS A DAY ON THE MOBILE HEALTH CLINIC
THE DAY THE UNTHINKABLE HAPPENED
12
A Mile in the Board of Nursing’s Shoes
14
How Nurses Work Daily to Protect the Profession
10
THE IMPACT OF WINKLER COUNTY
18
A Decisive Response to a Never Event
Contents IN EVERY ISSUE
FEATURES
5
8
9
20
22
PRESIDENT’S NOTES
UNPREDICTABLE BUT REWARDING
ADVERTORIAL
A DAY CONNECTING NURSES TO SUPPORT
Advocacy Every Day
Each Day As a School Nurse Presents Unique Challenges
TPAPN Case Managers
THE BACKBONE OF CONTINUING NURSING EDUCATION IN TEXAS
16
21
23
FAILURE IN PAIN MANAGEMENT
THE NURSE CANDIDATE
6 TNA MEMBER NEWS Kudos
THE TEXAS PRESCRIPTION MONITORING PROGRAM
Enough Is Enough
PAGE 3
Engaging the Community by Running for Office
ADVERTORIAL
FROM VETERAN TO NURSE: HOW TEXAS TECH HELPS VETERANS TRANSITION CAREERS
FA L L 2 019 | T E X A S N U R S I N G M AGA Z I N E
Alison Pittman,
PhD, RN, CPN, CNE, CHSE
UNDERGRADUATE:
RN to BSN Program, Traditional BSN, and Second Degree BSN
MASTER’S:
MSN-Nursing Education, MSN-Forensic Nursing, and MSN-Family Nurse Practitioner + 350+ clinical practice sites across Texas + Face-to-face instruction offered in BryanCollege Station and Round Rock + Flexible online course completion of RN to BSN and MSN degree programs + Ranked in Top 10 of nursing colleges in Texas by Nurse.org + 99% NCLEX® first-time pass rate, 100% AANP first-time pass rate The baccalaureate degree programs in nursing and master’s degree programs in nursing at Texas A&M University College of Nursing are accredited by the Commission on Collegiate Nursing Education (http://www.ccneaccreditation.org).
For more information, visit nursing.tamhsc.edu.
President’s Notes Jeff Watson, DNP, RN, NEA-BC
ADVOCACY EVERY DAY My Shifts with Connie
Too often, I think we believe that advocacy requires something more of us than what we can offer. Connie taught me that advocacy is simple; it’s an everyday practice. It emerges from knowing who you are and for what you stand.
MORE THAN TWO DECADES AGO, I met Connie, a registered nurse unlike any nurse I had met before. She was gregarious, funny, principled, passionate, uncompromising, and unstoppable. She possessed an unmatched generosity of spirit. Connie’s boundless compassion for everyone in her life was a fascinating witness to the everyday advocacy in which she engaged. She was one of those individuals who, despite numerous hardships and heartaches, had learned to lean into the life she was given. Every Advent season, Connie would take the time to bake a rum cake for each employee on the unit as her gift of gratitude. (They were delicious!) She routinely volunteered to work holidays, noting that the holidays were for nurses with children at home. I recall working a 3-11 p.m. shift with Connie one New Year’s Eve. When our work was done, she emerged from the nurse’s lounge with a bottle of sparkling white grape juice and plastic champagne glasses. Guided by the diet list, Connie went room-to-room. If the patients were awake, she invited them to share in a celebratory sip and then cheerfully wished them a Happy New Year!
Connie preferred working with lower acuity, chronically ill patients, particularly those with economic challenges. She was an astute clinician, paying careful attention to how patients would manage their illness in the community once discharged. Instinctively, she knew that the assessment of life struggles was as critical as the comprehensive clinical management of any chronic disease. One day I was in charge, and we were attempting to obtain durable medical equipment (DME) for one of Connie’s patients before discharge. After hours of trying to find resources, the social worker informed us that the patient would have to pay a relatively small out-of-pocket fee for the DME. A little while later, I noticed Connie standing outside of the patient’s room with the local DME vendor who delivered the equipment. I watched as Connie wrote a check to cover the cost for the patient. The end of the shift had come, and true to form, Connie was beginning her charting, pen in her right hand and rosary in her left. I stopped to ask what happened with the patient regarding the DME. She told me that it all worked out
PAGE 5
okay; the patient got what was needed. I asked no further questions and left her to finish her documentation. While this was the first time that I saw Connie cover gaps for people in need, it would certainly not be the last. In addition to her efforts inside the hospital, I learned over time that Connie was a vocal advocate in local civic and faith circles, championing the rights and needs of people with disabilities. She vowed to never let injustice go unchallenged. Connie lived simply, but not silently. Nurses spend our days and nights in a variety of health care settings, interfacing with any number of colleagues and patients as we go about our work. And, like Connie did for me, somewhere along the way, something or someone in the course of practicing our profession changes us. Too often, I think we believe that advocacy requires something more of us than what we can offer. Connie taught me that advocacy is simple; it’s an everyday practice. It emerges from knowing who you are and for what you stand. Peace, Jeff i
FA L L 2 019 | T E X A S N U R S I N G M AGA Z I N E
TNA MEMBER NEWS SPOTLIGHT ON YOU KUDOS Congratulations to the 2019 American Nurses Association Committee and Board Appointees: Renae Schumann, PhD, RN, Second Alternate, Committee on Bylaws
Leslie Kathleen Morris, MSN, RN, Member, Committee on Honorary Awards Subcommittee
Mary E. Vitullo, BSN, BA, RN, Second Alternate, Professional Policy Committee
Edtrina Moss, PhD, RN-BC, NE-BC, Third Alternate, Professional Policy Committee
Erin Perez, DNP, APRN, ACHPN, ANP-C, was selected as the Hospice and Palliative Care Nursing Association APRN certificant of the year. Perez is a member of the TNA End-of-Life Task Force and vice-chair of the Texas Palliative Care Interdisciplinary Advisory Council.
Denise Benbow, MSN, RN, FRE, was inducted as a Fellow of the National Council of State Boards of Nursing Institute of Regulatory Excellence during the NCSBN Annual Meeting and Delegate Assembly, August 21-23, 2019. Benbow earned a BSN from the University of Florida and a MSN from the University of Phoenix. She’s been a nurse consultant with the Texas Board of Nursing since 2007 with over 30 years of experience predominately on a cardiac telemetry floor including as staff nurse, unit educator, and relief charge nurse. Governor Greg Abbott appointed five nurses to the Texas Board of Nursing for terms set to expire on January 31, 2025. The board oversees the practice of professional nursing, examination of students, and standards of professional conduct for license holders. The board also prescribes and publishes the minimum requirements and standards for course studies in various nursing degree programs.
Congratulations to appointed TNA members Carol Kay Hawkins-Garcia, LVN, RN, and Laura Disque, MS, CGRN. Hawkins-Garcia is a vocational nursing instructor and assistant professor at Coastal Bend College and serves as a staff nurse at University Hospital. She earned an Associate of Applied Science in nursing from San Antonio College and a Bachelor of Science in nursing from Texas Tech Health Sciences Center. Disque serves as the transplant administrator for Doctors Hospital at Renaissance and serves as a board member for the Renaissance Cares Foundation. Disque received an Associate of Applied Science in nursing from Victoria College, a Bachelor of Science in psychology from Texas State University, and a Master’s in nursing administration from the University of Phoenix. i Please send member news (e.g., promotions, awards, board or committee appointments) to editor@texasnurses.org.
BE A TNA SOCIAL MEDIA AMBASSADOR
New to Twitter? Already follow us? Don’t even have an account? We want YOUR help in reaching nurses on social media in exciting new ways. TNA members Lisa Boss, PhD, RN, ACNS-BC, CNE, and Lisa Campbell, DNP, RN, PHNA-BC, are avid tweeters and great examples of TNA ambassadorship online. Campbell says nurses can serve as subject-matter experts on Twitter and offer an important perspective. To be most effective, she says “consider including a link to a recently released study, an infographic,
or post—one great way to engage with others. ”Designing your Twitter “handle” with a professional image is key for Boss. “Take time to observe the ‘culture’ of Twitter,” she says. “Once you are comfortable, chime in and let your voice be heard!” Read more about how Campbell and Boss (and other #nurseswhotweet) approach Twitter at texasnurses.org/news.
Ready to be a TNA social media ambassador? Get started by following and retweeting @texasnursesassn on Twitter, using the hashtag #NursesWhoTweet, and sharing our content via Facebook and LinkedIn. Your engagement grows our reach exponentially and ensures stakeholders hear about the great work we’re accomplishing.
T E X A S N U R S I N G M AGA Z I N E | FA L L 2 019
PAGE 6
UNPREDICTABLE But Rewarding Each Day As a School Nurse Presents Unique Challenges By Karen S. Schwind, BSN, RN, NCSN, New Braunfels ISD Texas, Health Services Coordinator
“You can’t educate a child who isn’t healthy, and you can’t keep a child healthy who isn’t educated.” –JOYCLEYN ELDERS BEING A SCHOOL NURSE is the most rewarding and most challenging position I’ve had as a registered nurse. Each day is unpredictable and often involves being the only medical person in the building. A school nurse must be quick to respond in case of an emergency and quick to reply to any request, from soiled clothes to vomiting to injuries to life-threatening emergencies without any medical assistance until EMS arrives. School nursing is defined by the National Association of School Nurses (NASN) as a specialized practice of nursing, which protects and promotes student health, facilitates optimal development, and advances academic success. School nurses, grounded in ethical and evidence-based practice, are leaders who bridge health care and education, provide care coordination, advocate for quality student-centered care, and collaborate to design systems that allow individuals and communities to develop to their full potentials. The typical day goes by fast, beginning with morning medications and procedures. Administration of medications and inhalers along with glucose checks, gastrostomy tube feedings and tracheostomy care may occur midmorning and again mid-afternoon. At noon, another round of students come through for inhalers, medications, diabetes checks, and insulin administration. The school day ends with preparation for students with medical needs to ride
the bus or day care vehicle. This may also be the time for documentation, to contact parents for referrals and follow up appointments, or for committee and staff meetings and training. NASN’s 21st century framework provides the standards of practice for the school nurse in the areas of communication, leadership, quality improvement, and public health—all with the student at the center of practice. Student health and academic success are the school nurse’s ultimate goal.
School nurse Amber Cichocki, BA, RN, CPN, assists a student at Carrollton Farmers Branch ISD.
Unfortunately, in the state of Texas, a nurse is not a required mandated position. It is the decision of each local school board to hire nurses and determine the model for student care. For many children, the nurse is the first medical professional they have contact
T E X A S N U R S I N G M AGA Z I N E | FA L L 2 019
PAGE 8
with and for some, the school nurse is the only medical contact. In any given school day, at any given moment there is potential for: Injury in athletics, physical education class, or the playground
Allergic reactions and anaphylaxis
Substance use or overdose
Asthma issues, some diagnosed and treated and some untreated
Diabetes, both types 1 and 2, insulin pens, pumps and Continuous Glucose Monitors apps
Students presenting with threats of suicide and mental health issues
Unexpected pregnancy that has not yet been shared with parents
Illness including fever, communicable disease, headaches, and gastrointestinal discomfort.
Additionally the school nurse is responsible for immunization compliance and ongoing parent education, billing, staff education on helping students in classrooms, vision and hearing tests and referrals, spinal screenings, and more. As a school nurse administrator, I continue to love what I do. I also have the ability to mentor nurses new to school nursing and pass on my love of caring for our most precious population, the children of our future. For more information, visit TXSNO.org. i
ADVERTORIAL
THE TEXAS PRESCRIPTION MONITORING PROGRAM HELPING NURSES COMMUNICATE WITH PATIENTS TALKING WITH YOUR PATIENTS about safe and effective alleviation of pain can be challenging. While prescription opioids are sometimes part of a comprehensive pain management plan, there are several possible ways to address patients’ pain and overall well-being.
The PMP tracks a number of controlled substances and can help you make smarter prescribing decisions. When you start a patient conversation about pain management, begin by checking the Texas Prescription Monitoring Program (PMP) as a registered prescriber or delegate. The PMP tracks a number of controlled substances and can help you make smarter prescribing decisions. Having a policy for prescription pain medications in place can help frame the conversation about pain management. For example, if your policy states that patients may receive prescription pain medications from only one physician or provider at a time, it makes it easier to talk with patients about other ways they can get comfortable. In addition to tracking controlled substances,
the PMP also provides information about the number of prescribers issuing, and pharmacies dispensing prescriptions. Prescribers and their delegates may consider integrating the following guidelines to facilitate the conversation about safe and effective alleviation of pain:
Use motivational interviewing techniques, including asking open-ended questions, to encourage patients to share their own stories about their health.
Allow patients to explore their own circumstances and options. When paired with clinical guidance, this helps to identify psychosocial factors that could be contributing to patients’ experiences of pain.
Help patients feel cared for by offering affirmations when patients talk about positive coping strategies that have worked for them in the past.
For additional information about the Texas PMP, please visit texaspmp.org. Remember to sign on before you sign off. i
healthytxyouth.org
If you have received: Letter of Investigation from the Texas Board of Nursing Notice of Peer Review
Joyce Stamp Lilly RN JD Registered Nurse and Attorney
713.759.6430 jslilly@me.com www.nurse-lawyer.com
PAGE 9
FA L L 2 019 | T E X A S N U R S I N G M AGA Z I N E
THE IMPACT OF WINKLER COUNTY A Decisive Response To a Never Event By Cindy Zolnierek, PhD, RN, CAE
This article continues our Winkler Co. 10-year retrospective. Read the previous articles online at texasnurses.org /TNmagazine. In health care, the most serious occurrences threatening safety are called sentinel events. The National Quality Forum refers to devastating sentinel events, including criminal activity, as never events, which require immediate responses and corrective actions to prevent recurrence. The retaliation against Vickilyn Galle, RN, and Anne Mitchell, RN, who reported a physician to the Texas Medical Board (TMB), was a never event. After the nurses’ criminal charges and civil suit were resolved, Winkler County Hospital was cited and fined. Despite being vindicated in court, the damage was done to the two nurses. Galle and Mitchell had spent most of their careers at Winkler Memorial Hospital in the community of Kermit—a place to which they could not return. Mitchell ultimately found a nursing job in New Mexico and Galle took early retirement.
be construed as criminal, let alone a felony. 3.
Provided additional protection for nurses, including nurses who advise others of their rights and the nurse advocate role. The PAPL covers all retaliation, not just from the employer. (In the civil suit, the physician argued he couldn’t have retaliated against the nurses because he wasn’t their employer. Yet, power differentials can create a means for retaliation).
4.
Enhanced penalties for retaliation so agencies could impose fines significant enough to act as a deterrent, up to $25,000. Ten years ago, the Texas Department of State Health Services could fine the hospital only $1,300: $650 for each nurse. Likewise, validating several patient safety concerns and concluding the physician had illegally retaliated against the nurses, TMB issued the maximum allowable fine of $5,000.
We knew a policy solution was needed. In 2011, the Texas Nurses Association (TNA) worked with Senator Jane Nelson and Representative Donna Howard to sponsor and pass the Patient Advocacy Protection Law (PAPL; SB 192, HB 575) to strengthen legal protections for nurses who speak out for patient safety. The PAPL: 1. Established “good faith” rather than “without malice” as the standard for making protected reports. During the criminal trial, the prosecution suggested Mitchell made the report to the TMB because she didn’t like the physician (with malice), rather than due to patient safety concerns. A “good faith” standard establishes the basis for the complaint on the safety issues, rather than regard for the physician. 2.
Provided immunity from criminal liability for patient advocacy activities. No one ever imagined that the act of patient advocacy could
Another provision which extended protections to public employees passed in 2013, after being introduced in the previous two sessions (2009 and 2011). All public employees are protected from retaliation for reporting violations of law to the appropriate authority and have access to certain remedies through the Texas Whistleblower Law. However, these protections are more limited and more difficult to access than those in the Nurse Practice Act because of sovereign immunity. Sovereign immunity protects public entities from civil lawsuits, including state and county hospitals, public universities, and correctional facilities. Because Winkler
T E X A S N U R S I N G M AGA Z I N E | FA L L 2 019
PAGE 10
County Hospital is a public facility, the nurses at the time could only sue the hospital under the Whistleblower Act and not the additional patient protection activities included in the NPA such as: Reporting patient care concerns within the facility. Refusing to engage in conduct that violates the NPA or rules of the Board of Nursing. Requesting safe harbor nursing peer review. Reporting licensed practitioners and facilities to their respective licensing boards or accreditation bodies because of a failure to meet accepted practice standards. A 2013 limitation on sovereign immunity now allows publicly employed nurses participating in patient advocacy activities the ability to file civil lawsuits under the NPA. TNA also fought legislation introduced in 2011, 2013, and 2015 that would have removed the confidentiality of reports to TMB. Winkler County nurses Mitchell and Galle testified to the harsh repercussions that can occur without confidentiality. Since its inception in 1907, and first successful legislative policy effort in 1909 when the original Nursing Practice Act was established, TNA has worked to support patient safety by advancing nursing practice through policy initiatives. Because of that work, Texas nurses enjoy strong advocacy protections. As the Winkler County case and its aftermath shows, patients are better served when nurses can speak up for safety without fear of retaliation. i
If not now, when?
The faculty team at Cizik School of Nursing are nurse educators, practitioners, scholars, and internationally recognized researchers committed to educating tomorrow's nurse leaders. Educated in many of the nation's leading hospitals, our students receive one of the finest nursing educations and experiences available in the world.
Academic Offerings
RN to BSN RN to MSN MSN Post-Master's
BSN to DNP - NP Nurse Anesthesia PhD
Learn more and apply online today at nursing.uth.edu
RESPONDING TO A CRISIS THE DAY THE UNTHINKABLE HAPPENED By Kanaka Sathasivan, MPH, Director of Communications, Texas Nurses Association
“IT FELT LIKE A NORMAL SATURDAY. Everything looked normal,” recalled John Duran, MSN, RN, assistant chief nursing officer at Del Sol Medical Center.
THE FIRST HOURS On August 3, 2019, a gunman attacked shoppers at a Walmart in El Paso, killing 22 and injuring 24 others. Victims were transported to two medical centers, the University Medical Center of El Paso and Del Sol Medical Center. The nurses at both facilities faced a deluge of patients with severe injuries, confused and upset families, and press seeking updates. Off-duty nurses were notified through an automated system and rushed in to provide support. Duran lives less than a mile from Del Sol Medical Center and was the first person to respond to the call. He immediately took up the role of incident commander and set up in a classroom. “The hospital was still empty and quiet.” Duran said. “In 20 to 30 minutes, people poured in. Some were called to help, but a lot of people just heard and came in on their own.” Perla Falconi, BSN, RN, emergency room nurse at Del Sol Medical Center, had just finished watching her son’s soccer game and was driving home when her director called her in. After dropping her
All three nurses pointed to one thing that helped them function seamlessly that day: a citywide active shooter drill. husband and kids off, she went straight to the hospital. She vividly remembers the look on her coworkers’ faces when she walked in. “Radio reports were coming in one after the other after the other. I could see so many emotions on each face. They were worried, scared, but I also saw so much confidence and bravery.”
INCIDENT COMMAND Duran wanted to set a strong foundation as staff and executives reported to incident command for their assignments. “First, I asked the med-surg and throughput team to start downgrading existing patients and move them to make room.” Emergency rooms (ERs), operating rooms (ORs), and intensive care unit (ICU) rooms were made available for the incoming patients. “I sent critical care nurses to take care of the new patients, to transfer them throughout the day from ER to OR to ICU seamlessly.” Annie Garcia, MSN, RN, CNML, chief nursing officer at Del Sol Medical Center, started planning even before she got to the hospital. The executive team filled different roles than they did day to day; for example, the chief executive officer
T E X A S N U R S I N G M AGA Z I N E | FA L L 2 019
PAGE 12
handled communications and media. Garcia supported multiple departments, but also had to plan for communicating with families, working with law enforcement, and helping with investigations. “We had so many resources,” she said. “Special victims unit, the federal bureau of investigation, the local police. They supported us and the victims, and we helped with their needs while also protecting our patients.” Duran, Falconi, and Garcia agree it was a day like no other. “Coming that day was very different,” Garcia said. “It was our community. It wasn’t just a car accident, where you can triage and consider severity. The number of patients, the severity of their injuries, and the patients coming in all at once—we needed all our resources at the same time.” “We weren’t dealing with something you see daily, and it was challenging to maintain calm,” Duran said. “There was a lot going on at once. But the team delivered. I thought it would be hard to get enough staff in, but we had 100 people show up. It blows you away. Seeing everyone come together was the most
From the importance of teamwork to the value of the practice drill to the emotional strength needed in to help a community in crisis—all three nurses hope that other Texas nurses will be able to learn from what happened in El Paso. amazing thing I’ve ever seen.” All three nurses pointed to one thing that helped them function seamlessly that day: a citywide active shooter drill.
PREPARING FOR THE WORST In October of 2018, at night when hospitals and medical centers across the city have the fewest resources, the city of El Paso staged an active shooter scenario at the airport. Physicians, nurses, and even students responded to the call to help—over 100 respondents at Del Sol Medical Center alone. Volunteers played the role of patients, and staff enacted placing them in appropriate units. Nurses communicated with other facilities, simulated emergency transfers, and matched clinical staffing to the needs presented. “The drill was surprisingly accurate,” said Falconi. “Everything we practiced for and the way we practiced—it was spot on.” And it paid off. “You see it on the news, but you never think it could happen to you,” Falconi
said. “You really have to know what to do and how for it to work in an emergency. Teamwork is the only way to go about it. No matter what you are assigned, you are doing something important to achieve a common goal.” In addition to strengthening team bonds, the drill helped staff improve communication and prepare for chaos. Garcia remembers how impressed she was with the team both during the drill and on August 3. “Everyone knew their role and purpose and worked at their highest capacity. We had a special area allotted for families. We had community resources like crisis centers and spiritual support. It emphasized how important teamwork is. We practiced and when it was the real thing, everyone executed so well.”
MORE THAN JUST ONE DAY Things moved quickly on August 3. Nurses helped families with the ID process and provided information on their loved ones. Most patients had multiple health care staff all working together to treat
their severe injuries. Throughout the day, incident command processed reports, allocated resources, and gave assignments. While the work itself was familiar, the nurses faced a huge emotional burden as they treated their neighbors. “Even though we often take care of trauma patients, we’ve never dealt with this before,” said Falconi. “The nurses here are like a family. People enjoy being here. But that day was more somber.” Garcia and Duran made sure nurses had the resources they needed, even before the nurses knew they needed them. Employee Assistance Program counselors were available, every department did a debrief, and other hospital staff provided support. Facing a crisis like this doesn’t just last a day. “For some of us, all those emotions set in a week or 10 days later,” Garcia said. “So we still have that support available for our employees.” From the importance of teamwork to the value of the practice drill to the emotional strength needed in to help a community in crisis—all three nurses hope that other Texas nurses will be able to learn from what happened in El Paso. “We are all nurses; we are prepared to take care of patients,” Duran said. “It’s difficult to have these conversations or talk to media and recall these events. But we want to help other nurses be better prepared to respond.” The staff at Del Sol Medical Center received an outpouring of support in the days and weeks following the shooting. Letters, cards, messages, and thank you notes came in from across the state and even from outside of Texas. To the community, Garcia, Duran, and Falconi would like to express their gratitude: “We are very proud to be a part of Texas. We are grateful to the community and everyone who contributed. We appreciate everyone’s love, thoughts, and responses.” i
Editor's note: We express our gratitude to Del Sol Medical Center and their nurses for speaking about the events of August 3. The Texas Nurses Foundation provides resources for nurses in disaster situations through Care for the Caregiver. Learn more: texasnurses.org/C4C.
PAGE 13
FA L L 2 019 | T E X A S N U R S I N G M AGA Z I N E
BRINGING CARE TO RURAL PATIENTS A DAY ON THE MOBILE HEALTH CLINIC By Barbara Chapman MSN, APRN, FNP-C
MOBILE HEALTH CARE AND TELEHEALTH: a powerful combination of services that can provide patients access to care. Imagine a large van, winding through the back roads across Texas, equipped with medical supplies for analyzing blood pressure, testing for diabetes, and communicating with medical and behavioral health specialists via onboard telehealth equipment. Meet the INTUNE Mobile Health Clinic in Cherokee County, Texas, which brings health care to folks in underserved areas who have limited access to services.
Through the INTUNE and TRUE NORTH grants, acquired through the University of Texas at Tyler, and services offered through Special Health Resources, a federally qualified health care center, the clinic sees patients on a sliding scale payment system, meaning no one will be turned away from care. It was 4:30 a.m., dark, raining, and I was ready to start my two-and-a-half-hour drive to the rural East Texas town of New Summerfield, “The Plant Capital of the South.” As a board-certified family nurse practitioner and part of the developmental team of INTUNE, I love being able to travel to help those who have little or no access to health care.
CREATING THE MOBILE CLINIC In rural areas across Texas, there is a tremendous need to increase access to care. INTUNE operates like a brick and mortar facility, but our facility is on wheels.
LEFT: (From left, back) Michael Lyons, Barbara Chapman, Tammi Kelly. (front) Kari Kennel, Lauren Gandy. MIDDLE: Intune gives out 100 backpacks full of supplies to New Summerfield children. RIGHT: Intune staff Claudia Rangel and Estela Rodriguez with Mayor Jane Barrow and Police Chief Reynold Humber.
With the mobile clinic, we can reach drastically underserved towns like New Summerfield. Providing affordable preventative services or assisting in early treatment for chronic disease improves overall health and quality of life outcomes. Through the INTUNE and TRUE NORTH grants, acquired through the University of Texas at Tyler, and services offered through Special Health Resources, a federally qualified health care center, the clinic sees patients on a sliding scale payment system, meaning no one will be turned away from care.
T E X A S N U R S I N G M AGA Z I N E | FA L L 2 019
PAGE 14
“Making health care accessible is our mission, and the INTUNE mobile clinic represents the heart of what we want to accomplish. The idea is to help people get access to resources while maintaining the dignity and respect they deserve,” said Patrick Evans, Special Health Resources. The mobile clinic also precepts and trains family nurse practitioner students on mobile rural health care. Soon, we will bring psychiatric mental health nurse practitioner students on board to assist in patient evaluations and treatments utilizing telepsychiatry as a component for these visits.
REACHING THOSE IN NEED That early and rainy morning, I arrived at the mobile unit to find a line of people waiting to receive care. Our team mobilized to usher those with and without umbrellas to shelter in the City Hall building next door to the unit. I thought to myself, “We are going to be busy!” The mission of the INTUNE mobile unit is to provide services while treating people with dignity and compassion. Our 44foot mobile unit is open from 10 a.m. to 6 p.m., Mondays and Wednesdays, and operates with two exam rooms, a small lab, patient intake area, and a bathroom. The small space meant our team quickly became a family. In 14 minutes, we set up all the equipment and got computers with internet up and running. As patients are registered into the electronic health system, we talk to and treat each person one by one. I see patients ranging in age from three to 78 with symptoms from ear infections to diabetes and hypertension.
Lack of access to care and inability to travel are the biggest problems facing rural communities, so we try to provide as many cost-effective services on site as possible. For instance, point-of-care blood analyzers allow us to evaluate test results in real time without having to send patients to another location. Mayor Jane Barrow said, “This mobile unit will help our residents be able to stay in New Summerfield and get medical care rather than driving to other towns around us.” After many long hours, it is dark again, and I am ready for the two-and-a-halfhour commute home. As we finished the day, one of our patients came to shake my hand and thank me. I asked how the mobile unit affected his overall health. He responded: “Estas haciendo el trabjo de los ángeles.” “You are doing the work of angels.” i 1. Mobile health units put emphasis on access for mHealth. (2017). Retrieved from mHealthintelligence. com: https://mhealthintelligence.com/news/mobilehealth-units-put-the-emphasis-on-access-for-mhealth
TE X A S PEER ASSISTANCE
PROGRAM FOR NURSES
Recovery Support for Nurses TPAPN PARTICIPATION Need help with recovery? Worried about a peer’s behavior? Have questions about substance use or mental health? TPAPN provides resources, expertise, case management, and peer support for nurses. We encourage early intervention to prevent nursing practice violations and Board of Nursing disciplinary actions, and we use a personalized approach to help nurses prioritize their health and maintain their practice.
Director of Nursing To apply and view the job description:
https://apptrkr.com/1653685
Contact us to refer yourself or a peer, or just to get your questions answered. Call 1-800-288-5528 or visit tpapn.org.
tpapn.org
Lee College does not discriminate on the basis of gender, disability, race, color, age, religion, national origin, or veteran status.
PAGE 15
FA L L 2 019 | T E X A S N U R S I N G M AGA Z I N E
FAILURE IN PAIN
MANAGEMENT
ENOUGH IS ENOUGH By Gloria Duke, PhD, RN
Days watching loved ones in hospice reveal need for updated pain management practices. “Pain finds its way everywhere, into my vision, my feelings, my sense of judgment; it’s an infiltration … You have to die so many times before you die.”
—Alphonse Daudet, In the Land of Pain, 1840-1897 THE NIGHT MY MOTHER PASSED, she was in a free-standing hospice inpatient facility. I trusted the nurses there to meet her pain and other needs. However, despite a kind and caring demeanor, the on-call nurse showed reticence when I told her mom needed more pain medication. She only agreed to contact the physician after I told her I would if she didn’t. Sadly, four and a half hours before my mom breathed her last breath, I had to beg for her pain relief because a nurse was protecting her license. This summer, my 87-year-old aunt was admitted into an acute-care facility with sepsis. After three to four weeks, they were able to control her unrelenting delirium and pain. But when she transferred to a long-term center, she completely regressed. Her physician refused to give her anything for relief so “she could wake up and tell us where she’s hurting.” After a week, our family and I chose to transition her to hospice care, thinking she could at least get pain relief. We were wrong.
The staff were not equipped to provide sublingual or subcutaneous drip morphine, the standard of care for hospice patients. It took another four agonizing hours before my aunt finally received intravenous morphine. Three hours later, she was finally calmer. She passed two days later. Being a hospice nurse, I knew firsthand that physicians can be reluctant to prescribe medication for pain management. However, I never expected to face reluctance from hospice nurses when seeking care for my family members. Struggling to get them the pain management they needed opened my eyes to knowing how I can be more of an advocate for my patients, family members, and the many people asking me for advice when they have no one else to turn to. Why, after decades of research on pain management, are we still experiencing these situations? Knowledge and attitudes about pain and pain management have changed little over previous decades.1-5 Despite
T E X A S N U R S I N G M AGA Z I N E | FA L L 2 019
PAGE 16
the fact that the burden of pain adversely affects quality of life, pain continues to be undertreated.6,7 Have we as health care providers become more immune to these cries for help to the point we can ignore them? At both these institutions, I believe the nurses did the best they could in conveying patient needs to physicians, and from my perspective, situations like this reflect a sense of powerlessness on the part of the nurses and possibly, the physicians.
Advocacy is a pillar of nursing and, as pain management crosses the health disciplines, advocacy should not be unique to only nursing. Non-discriminatory pain relief is a basic human right and ignoring that right may be considered professional negligence.8,9 Many providers overlook their ethical obligations when treating pain. Advocacy is a pillar of nursing and, as pain management crosses the health disciplines, advocacy should not be
unique to only nursing.10, 11 Changes are necessary for facilitating advocacy, empowerment, and critical thinking for effective pain management in all settings, across disciplines, and at the policy level. Every person under “official” hospice care, despite the setting, must have access to all forms and routes of medications that effectively manage pain and other symptoms. This also applies to those in non-hospice settings, such as acute-care and long-term care settings. No person should ever have to wait and suffer. As we speak, unmanaged and moderate to severe pain is experienced all around us. My mother and my aunt had me as a registered nurse to advocate for them, but what happens when no one knows how to advocate or even knows there are other options for pain management? My passion for helping alleviate suffering drives my goal to open the eyes of other health care providers—especially physicians and nurses who are treating pain—just as mine were opened from being on the other side of the process with my mother and aunt. Together, we can eliminate myths, barriers, and stereotypes about pain management so quality of life can be improved for countless people in need. Texas Nurses Association will have more information on the website in 2020 for helping patients in palliative care. i REFERENCES 1 Chia, G.S., Yap, G.S., & Won, Y.Y. (2018). Knowledge and attitudes about pain management among nurses in Singapore. Journal of Pain and Symptom Management, 56(6), e116. 2 Craig, JA. 2014. Nursing knowledge and attitudes toward pain management. 3 Duke, G., Haas, B., Yarbrough, S., & Northam, S. (2013). Pain knowledge and attitudes in baccalaureate nursing students and faculty. Journal of Pain Management in Nursing, 14(1), 11-19.
The World Health Organization has declared 2020 to be the Year of the Nurse and Midwife in honor of the 200th anniversary of Florence Nightingale’s birth.
Nurses and midwives make up over 50% of the health care workforce across the world, but also more than 50% of the shortage in health care workers. This is the year to celebrate nurses and midwives, and for nurses to get more involved in influencing the future of nursing!
PAC DONATION HAVE YOU MET THE $20 CHALLENGE YET? TEXAS NURSE PAC is the officially-sponsored political action committee (PAC) of the Texas Nurses Association. We contribute to candidates on both sides of the aisle. Help TNA refresh its financial PAC resources to help candidates that support nursing and health care. If every member donated just $20, we could have a fighting chance at the Capitol!
Give at texasnurses.org/PAC. Contributions to TEXAS NURSE PAC are not deductible as charitable contributions for federal tax income purposes.
4 Ryan, P; Vortherms R; Ward, S. (1994). Cancer pain: knowledge, attitudes of pharmacologic management. Journal of Gerontological Nursing, 20(1) p. 7–16.
TEXAS
5 Ung A, Salamonson Y, Hu W, Gallego G. (2016). Assessing knowledge, perceptions and attitudes to pain management among medical and nursing students: a review of the literature. British Journal of Pain. 10(1), 8–21. 6 Brennan, F., Carr, D., & Cousins, M. (2016). Access to pain management—Still very much a human right. Pain Medicine, 17 (10), 1785-1789.
8 U.S. Pain Foundation (2017). Patient bill of rights.
10 American Nurses Foundation (DU). Advocacy.
7 Dunn, P.M. (2011). Legal landscape of pain treatment: An overview of the legal, regulatory, and ethical issues relating to pain treatment. Practical Pain Management, 3 (2).
9 Souza, L. A. F., Pessoa, A. P. da C., Barbosa, M. A., & Pereira, L. V. (2013). [The bioethical principlism model applied in pain management]. Revista Gaucha de Enfermagem / EENFUFRGS, 34(1), 187–195.
11 American Nurses Association. (2015). Code of ethics for Nurses, with interpretive statements, Silver Spring, MD: American Nurses Association, Nursebooks.org.
PAGE 17
FA L L 2 019 | T E X A S N U R S I N G M AGA Z I N E
A Mile in the Board of Nursing’s Shoes How Nurses Work Daily to Protect the Profession By Melinda Hester, DNP, RN-BC
T E X A S N U R S I N G M AGA Z I N E | FA L L 2 019
I RECENTLY RETIRED after working 40 years in nursing, a profession I was called a long time ago to join. I was a labor and delivery nurse, public health nurse, school nurse, and a university professor. But I think by far the hardest job I ever loved was working for the Texas Board of Nursing (Board). For almost 10 years, I worked as a nursing practice consultant and then, as my skill and expertise grew, as the lead practice consultant. The Board is a small state agency and not many nurses have had the opportunity to work for the Board and learn about nursing regulation. The Board and agency staff are decidedly committed to the mission of protecting and promoting the welfare of the public. This commitment requires courage in difficult and demanding circumstances. During natural disasters, when hundreds of nurses volunteer to enter Texas to help. During investigations and disciplinary actions when nurses failed to follow laws, rules and regulations and didn’t realize their role was to speak up, advocate and keep patients safe from harm. We are fortunate to be part of a profession that governs itself and to work in a state in which the Board is strong and courageous. Led by 13 highly educated and talented men and women, nine of which are nurses, the Board has more than 100 agency staff who work hard every day to follow the mission and vision that was developed by and for our profession. As the lead practice consultant, I translated the lessons we were learning into meaningful stories to prevent future practice errors. In nursing regulation, we often react to events or practice breakdowns; the challenge and excitement comes when we become proactive as regulators and assist nurses to understand their duty is to safeguard patients from harm. Board practice consultants communicate weekly with hundreds of nurses across the state who have complex questions about how laws, rules, and regulations apply to their particular challenging situations. The Nursing Practice Department develops articles for the Texas Board of Nursing Bulletin to keep nurses informed about changes to the law and how the Board views particular situations. Staff members lead jurisprudence and ethics workshops around the state to
PAGE 18
I am proud to be a part of a profession that is self-governing, where nurses determined their standards and ethical obligations. How we act and behave as nurses has been the driving force behind being the most trusted profession. teach nurses about the Nursing Practice Act, the Board’s mission, and the duty of every nurse in Texas to keep patients safe. No message is more important than patient safety and the protection of the public. As a nurse and a consumer of health care, there was nothing more important to me than trying to prevent another injury or error from happening to a patient or family. The Board collaborates with nursing constituents and stakeholders interested in services nurses provide to better develop rules and regulations, position statements, and guidelines. Organizations such as the Texas Nurses Association inform the development of these documents, which guide how we practice as nurses. Conflict is inevitable and often uncomfortable during the negotiation process; however, supporting all interested parties to reach an agreement can be exciting and gratifying. I am proud to be a part of a profession that is self-governing, where nurses determined their standards and ethical obligations. How we act and behave as nurses has been the driving force behind being the most trusted profession. I believe our profession enjoys this honorable distinction in part because of the Texas
Board and staff who care deeply about doing the right thing. As nurses, we have determined that it is important to treat our patients, clients, and families with respect, to be honest and trustworthy. We have decided, because of the intimate work we do with patients and clients, that we must always act with integrity. We must always do what is in the best interest of the patient and client even when it is difficult and even when no one is watching. i Interested in making a difference and a far-reaching impact in nursing? For more information on becoming a Board member, visit https://gov. texas.gov/organization/appointments/positions.
Rewarding Careers Join a team that is making a difference!
W
e offer predictable work schedules, set caseloads and an excellent benefits package, including: n New higher starting salaries for RNs n Health and retirement benefits n Paid vacation leave and up to 15 paid holidays a year n Shift differential pay
Find an exciting and challenging career in one of 23 health and specialty care locations across Texas.
Contact:
Apply online: hhs.texas.gov/about-hhs/jobs-hhs
PAGE 19
18D0738
Laura Hunter atof Aging Texas Department and Disability Services laura.hunter@hhsc.state.tx.us
FA L L 2 019 | T E X A S N U R S I N G M AGA Z I N E
A DAY CONNECTING NURSES TO SUPPORT TPAPN Case Managers Serve as the Glue Between Participants, Advocates, Employers, and Providers
WHEN MICHELE WIECKOWSKI, BSN, RN-BC, gets to her desk each morning, she arrives ready to jump in. Morning coffee already in her system, and homemade lunch stored in the fridge, she turns straight to her computer to do what she does every day: help participants in the Texas Peer Assistance Program for Nurses (TPAPN). As a case manager, Wieckowski handles a caseload of roughly 150 participants. Even with such a large group, she works to ensure each participant feels they are her only case. Her software first alerts her to the most pressing issues of the day—a participant’s positive drug screening or a call from a prospective employer of a new enrollee. As the day goes on, Wieckowski balances her caseload with other structured assignments and often must respond to a handful of surprise phone calls. TPAPN case managers wear many hats, namely, helping participants with paperwork and obligations, but also assisting with job interviews, teaching them how to talk about their enrollment in TPAPN in a positive way, and acting as a go-between for therapists, doctors, and employers. “You can go from talking to someone in the midst of a substance use crisis to talking to a psychologist about the care of another participant,” she says. A recent TPAPN restructure and new leadership has brought a host of change– case managers have gone through “motivational interviewing” training, and a redefined and separate peer-support partner role has freed up some former responsibilities for case managers.
MISCONCEPTIONS Wieckowski always poses the same question to new participants: “What have you heard about TPAPN?” It’s a mixed bag
but leans negative. “It’s tough,” she says. Initially, nurses are skeptical and have misconceptions. Self-enrollment is an option, but most participants enroll via a referral or order from the Texas Board of Nursing. Some have recently lost their jobs, and others are struggling to find work. Some are employed but embarrassed to talk about their enrollment. Wieckowski strives to help participants understand that while returning to safe nursing practice is the ultimate goal, so is bettering themselves, learning to cope, and leading a balanced and healthy life.
‘I’M A NURSE TOO’ “Nurses, I think, are naturally just bad at taking care of themselves,” Wieckowski says. As a nurse herself, she feels it’s important to form a bond with participants, specifically by being authentic. “When I’m talking to a new participant, I tell them, ‘I’m a nurse, I know how hard you worked for this license, I want to help you succeed.’” Because the case work is done over the phone, connecting with participants matters even more. “There’s so much wrapped up in being a nurse,” she says. “Nurses have such a strong identity in their role, so imagine they lose their job and feel like no one will hire them again. We help them see that not all is lost just because one bad thing happened.” However, some nurses are afraid to admit they need help. “They don’t want to be a burden on their team.”
SELLING THE PROGRAM Although stigma surrounding mental health and substance use disorder is decreasing, Wieckowski and the other case workers often must “sell” the program, both to participants and employers. Squashing some misconceptions is easy:
T E X A S N U R S I N G M AGA Z I N E | FA L L 2 019
PAGE 20
Employers don’t have to pay for drug testing, and when hiring a TPAPN nurse, employers are the first to know if an issue arises, because they’ll get a call from the case worker themselves. However, other assumptions about the program persist. Many participants “flip” their TPAPN experience to a positive—they are eager to prove themselves and determined to finish the program. It’s not just a way to keep their license, but a way to maintain their personal wellness. In addition, many employers view TPAPN participants to be some of their hardest working staff.
JOYS OF THE JOB “I have no interest in [participants] failing—my interest is in helping people succeed, and that’s what I get to do every day at my job,” Wieckowski says. While referring “unsuccessful” cases back to the Board of Nursing is among the more difficult tasks of the job, she says, “To hear, ‘TPAPN saved my life,’ is amazing.” “I don’t think many nurses have been given permission to take care of themselves and put themselves first,” she says. “I want to help them realize they can.” i
THE NURSE CANDIDATE Engaging the Community by Running for Office NIKKI ROUX, JD, MBA, BSN, RN, CEN, FACHE, NEA-BC, had always wanted to help people in need. So running for office was a natural fit. “I started out as a pre-law major,” she said, “then changed to nursing when my grandfather died of cardiac disease so I could do more to help people in need.” She later finished her law degree and business degree.
nity member Ryan Engolio. As a nurse, Roux stood out, and her background made her an ideal candidate. “There are many similarities between health care and education in the Humble area,” she explained. “You serve vulnerable groups, work in a highly regulated environment, have a rapidly growing population, and deal with limited resources. But you can have a significant impact on outcomes.”
Roux grew up in the small town of Sour Lake, TX, and she and her husband lived in the Katy area before deciding to move their family to Humble ISD so her kids could start school in the highly rated district. As chief nursing officer at Memorial Hermann Northeast, Roux worked with Humble ISD on a number of initiatives; she also volunteered with the superintendent on committees. Running to be a trustee seemed like a logical next step. “My husband and I are very interested in being involved in leading and directing our children’s education. Running seemed like a good way to be engaged and serve my community in a greater capacity.” Before she started the hard work, Roux had to make sure her most important supporters were on board: her family. “I had a meeting with my husband and children, and we talked about the time commitment and the pros and cons.” While her family knew that running meant less family time and more attention on each of them at school and in the community, they decided it was the right move. As part of the school board, Roux could influence the future of their learning and bring a diverse and valuable background in nursing to her position. She started her campaign by formally completing the paperwork showing her intent to run, and then she reached out to a former trustee for advice. “He connected me with some key community influencers. I met with them, and then they connected me to more community influencers, and so on.”
Ultimately, Roux came in second behind Scarfo, but she still views it as a positive experience. She cites three things she learned in running: “First, even an off-the-charts introvert like me can learn how to be successful in the campaign world. Second, people have to connect with you to support you. And third, even those who may not choose to vote for you will respect you when you conduct yourself with grace, respect, and dignity even in sticky political situations.”
Roux organized activities with those influencers and their community groups, and she prioritized attending key meetings happening in the district. Everywhere she went, she made sure to share her platform and values, personally encouraging people to vote for her.
She hopes her experience can encourage other nurses to consider running for local or state positions. “We have learned problem-solving skills in our profession that are translatable to many settings. And you can make a real difference in your local community.” i
Her running mates included well-known former board member Robert Scarfo, former teacher Janie Brannan, and commu-
Visit texasnurses.org/nursesinoffice to learn how you can run for local positions.
PAGE 21
FA L L 2 019 | T E X A S N U R S I N G M AGA Z I N E
THE BACKBONE OF CONTINUING NURSING EDUCATION IN TEXAS Continuing Nursing Education Committee Maintains High Standards for Education in Texas FOR THE MODERN NURSE, a wealth of courses exists to satisfy continuing nursing education (CNE) requirements. In Texas, a tried-and-true shining star is the Texas Nurses Association (TNA) Approver Unit, which is an accredited approver of nursing continuing professional development by the American Nurses Credentialing Center’s (ANCC) Commission on Accreditation (COA). When nurses take courses that go through
"The accreditation ‘stamp’ ensures the material is relevant, timely, evidence-based, and grounded in learning theory so the delivery will generate new personal meaning and the best possible learning.” TNA’s approval process or from providers who are approved by TNA, they can be assured of the quality and substance of the content. The CNE Committee, an official team of volunteer nurse peer reviewers and TNA staff, supports TNA’s Approver Unit. Committee members review individual activity applications—for educational events where TNA provides contact hours—and Approved Provider Applications—for organizations to show they meet ANCC COA and TNA standards to provide their own contact hours. All committee volunteers have prior experience working in nursing continuing professional development and experience with ANCC criteria and standards. TNA purposely seeks out a high-caliber group of nurses from across the state and across different specialties (e.g., academia, med-surg, critical care, and more) to serve on the CNE Committee. Chipo Ndlovu, PhD, RN-BC, director of education for TNA and the nurse peer review leader for TNA’s Approver Unit, says she hopes nurses “can see and understand the incredible work this committee is doing.” To be a committee member, she says, you must be called. One such nurse volunteer is Francine Snow, DrPH, MSN, CNE, RN-BC, who has served the committee for seven years. For Snow, the approval method is tedious but necessary. “The process ensures the activity is instructionally sound and time efficient, delivering the greatest learning in the shortest amount of time with the goal of equipping nurses with the knowledge and tools to do their job effectively in the 21st century. The accreditation ‘stamp,’ as she describes it, “assures the nurse that either I or another [committee member] has ensured the material is relevant, timely, evidence-based, and grounded
T E X A S N U R S I N G M AGA Z I N E | FA L L 2 019
CNE committee members pictured with TNA Director of Education, Chipo Ndlovu (front center), CNE Program Coordinator, Leann Ayres (back left), and CEO, Cindy Zolnierek (front right).
in learning theory so that the delivery will generate new personal meaning and the best possible learning.” Amanda Garey, MSN, RN-BC, C-OB, C-EFM, is one of the newer committee members. Her work as a bedside nurse and educator of 15 years helped her offer knowledge related to educational design, evaluation development and articulating meaningful outcome for nurses participating in CNE activities. It’s important, she says, that nurses themselves lead the charge in planning and implementing continuing education. “Nursing, as the largest health care profession, has the ability to lead evidence-based practices and impact patient outcomes through high-quality CNE activities.” During a recent CNE Committee meeting, members were treated with an in-person surprise recognition ceremony—a rare occasion as the group, in a state as big as Texas, mostly meets remotely. Ndlovu says she hopes to see CNE Committee grow from its current size of 22 members to 33 members and for nurses from diverse nursing backgrounds to join the committee. “I look forward to seeing more nurses with experience working with CNE joining this special team of nurses and becoming part of this wonderful committee. Together we can accomplish a lot and influence nursing continuing professional development for nurses in Texas and beyond.” Interested in serving on the CNE committee or learning more about how your organization can become an Approved Provider Unit? Email cndlovu@texanurses.org to learn more. i
PAGE 22
ADVERTORIAL
FROM VETERAN TO NURSE
How Texas Tech Helps Military Members Transition to a Nursing Career By Patricia Francis-Johnson, DNP, RN, Assistant Professor, Texas Tech University Health Sciences Center; Jana Saunders, Ph.D., APRN, PMH CNS, Professor, Texas Tech University Health Sciences Center; and Debbie Sikes, DNP, RN, CNE, Associate Professor, Texas Tech University Health Sciences Center THE TRANSITION FROM THE MILITARY to higher education can be traumatic and presents challenges for veterans, including new environment and new role expectations. Veterans must adjust to civilian life and taking on the role of a student. For Nick StClair, BSN, RN, PCCN-CMC, returning to school after nine years of active duty was a conscious decision. “After my transition to leadership in combat arms and later technical and leadership positions outside the military, something was missing. I liked the idea of more training, and Texas Tech helped me return to the first profession I loved.” To support veterans, Texas Tech University Health Sciences Center School of Nursing developed a 12-month accelerated Veteran to Bachelor of Sciences in Nursing (VBSN) program. VBSN students are representative of military personnel with people of various ethnicities, races, and social backgrounds. Veterans
often worked as licensed vocational nurses, health care specialists, or aerospace medical service apprentices. Health care training in the military develops strong skills but offers limited career advancement options. Many VBSN students face financial burdens, veterans education benefits challenges, and complicated higher education requirements. The program addresses this with guidance from a School of Nursing Veterans Liaison and supportive faculty, staff, and administrators. As StClair puts it: “The program isn’t made of curriculum and books, it’s made of people who care deeply about your success and you as a person. The program also provided me something I lost when I separated from the military: a real sense of family and belonging. I finally found home.” VBSN graduates now practice in a wide array of settings. One graduate owns a health care business. Several others are continuing their military service, advancing as commis-
Graduates of the VBSN program, from left: Cindy Gaucin, Alex Munoz, Joseph Fobbs-Hernandez, and Nick StClair.
sioned officers. Some have been recognized by their employers and honored with service awards. Above all, Texas Tech VBSN graduates are providing exceptional nursing care to their patients.i i To learn more, visit ttuhsc.edu/nursing and scroll to Programs at a Glance.
RN to BSN Tuition Only
$8,068
The online RN to BSN program at University of Houston-Victoria emphasizes the quality and safety of patient care providing you with the knowledge and skills to better the lives of others.
Affordable • 100% online coursework • Complete in 12 months • 5 starts per year The baccalaureate degree program in nursing at University of Houston-Victoria is accredited by the Commission on Collegiate Nursing Education, 655 K Street, NW, Suite 750, Washington, DC 20001, 202-887-6791.
Get started today! UHVNurses.com | 888-728-6625
PAGE 23
FA L L 2 019 | T E X A S N U R S I N G M AGA Z I N E
4807 Spicewood Springs Rd. Bldg 3, Suite 100 Austin, TX 78759
HELP TNA GET TO 16,000 MEMBERS From November to April, we’re launching
MEMBER GET A MEMBER. Current members can win prizes by getting their peers, students, or friends to sign up as a Texas Nursing Member. For more information, including a strategy guide and useful resources, visit texasnurses.org/MGM.
TAKE THE
YOUR NURSING CAREER.
OUR ONLINE GRADUATE PROGRAMS: Master of Science in Nursing Nursing Education / Nursing Administration & Leadership Clinical Nurse Leader
Doctor of Nursing Practice Family Nurse Practitioner / Adult-Gerontology
Acute Care Nurse Practitioner / Psychiatric Mental
Health Nurse Practitioner / Clinical Nurse Specialist / Post Master’s DNP
APPLY ONLINE at nursingcas.org harriscollege.tcu.edu/nursing graduatenursing@tcu.edu 817-257-6726