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TEXASNURSING M A G A Z I N E
2016 LEADERS AND LEGENDS OF TEXAS NURSING Honorees: Jim Willmann, Mary Fenton, Ellen Palmer, and Dolores Alford
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 | S p r i n g 2 0 1 6
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SPRING 2016 Volume 90, Number 2 EDITOR-IN-CHIEF: Cindy Zolnierek, PhD, RN MANAGING EDITOR: Kat Hinson 8501 North MoPac Expressway, Suite 400, Austin, TX 78759 P:1.800.TNA.2022 or 512.452.0645; F: 512.452.0648 tna@texasnurses.org texasnurses.org
MISSION Empowering Texas Nurses to advance the profession
VISION Nurses Transforming Healthcare 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 nonmember Texas nurses. Some back issues may be viewed online at texasnurses.org. 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.
BOARD of DIRECTORS Officers Margie Dorman-O’Donnell, MSN, RN, President Jeff Watson, MSN, RN, NEA-BC, CRRN, 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, MSN, RN, North Pam Greene, PhD, RN, South Patricia “Pat” Morrell, MSN, RN, East Patty Esposito, MSN, RN, NEA-BC, West Executive Director
Cindy Zolnierek, PhD, RN
TNA DISTRICT AND PRESIDENT Dist.1: Lawrence Giron, 915-742-1501, ljcares@elp.rr.com 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; 972-4352216; d4tna@flash.net; tnad4.org Dist. 5: Robert Walsh, 512-636-8036, Rlw1108@icloud.com, tna5.org Dist. 6: Rachel Ellis, 409-370-9600, rnellis@utmb.edu Dist. 7: Deborah Harrison, 254-760-0759, Nursedeb2001@gmail.com District office: P.O. Box 132, Belton, TX 76513 Dist. 8: Linda Juenke, 830-739-7028, ljsoaringeagle3@gmail.com Dist. 9: Robert Blake, 832-855-3359, RBlake9494@aol.com District office: Melanie Truong, 2370 Rice Blvd., #109, Houston, TX 77005; 713-5233619; tna9@tnadistrict9.com; tnadistrict9.com Dist. 10: Susan Wright, 254-498-3920, suwright@sw.org Dist. 11: Karen Polvado, 940-397-4047, karen.polvado@mwsu.edu Dist. 12: Greg Friesz, 409-365-4952, gfriesz@mac.com
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. 13: Vacant
POSTMASTER: Send address changes to TEXAS NURSING, 8501 North MoPac Expy., Suite 400, Austin, TX 78759-8396.
Dist. 16: Vacant
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/healthcare 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
Dist. 14: Joe Lacher, 956-882-5089, joe.lacher@utrgv.edu Dist. 15: Andrea Kerley, 325-670-4230, akerley@hendrickhealth.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, tmcdonald@hcecwildblue.com Dist. 25: Vacant 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
Printed on Recycled Paper
Copyright 2016 © Texas Nurses Association
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THE 2016 HOUSE OF DELEGATES MEETING Page 18
COVER:
photo by Carol Smith
2016 ANNUAL TNA LEGACY BANQUET Page 20
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PRESIDENT’S NOTES
TNA/ANA NEWS
UNFINISHED CARE
Awards
Researcher Delves into Impact of Nurse Staffing Conundrum
BRIDGE TO RECOVERY TPAPN Strives to Return Nurses to Safe Practice
BOARD OF NURSING FACES SUNSET
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PROBING MENTAL HEALTH AT THE STATE CAPITOL
COMMUNICATION SKILLS FOR PATIENT SAFETY
SOMEONE TO LEAN ON
Margie’s Legacy
Members On the Move Elections & Appointments
TPAPN Advocates Give Back to Nurses in Recovery
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President’s Notes Margie Dorman-O’Donnell, MSN, RN TNA President
THE BEST IS YET TO BE In 2011, Margie Dorman-O’Donnell was elected as president of the Texas Nurses Association. The last five years have been a time of great transition for TNA (see page 22). This issue marks Dorman-O’Donnell’s last President’s Column. As TNA president for five years, DormanO’Donnell has made a significant impact on the association and the nursing profession. Texas Nursing interviewed her to find out more about this nursing leader. Texas Nursing: What are you most proud of in the five years you have been president? Margie Dorman-O’Donnell: I am most proud of TNA’s increase in membership and that we made it to the other side of transition — we were on the precipice of uncertain change, and now we are on level ground with Cindy [Zolnierek] and the direction of the future for TNA. TN: What failure most helped you become a great leader? MDO: Well, I don’t feel like I’m a great leader. I’ve been able to enjoy success, but “great” seems to me limited to a very few special people. I appreciate the successes I’ve enjoyed, but it was with the help of many others. I will acknowledge that we’ve had great success as a group. As for failure, I picked the wrong college to attend for my first degree. I
thought I wanted to be a doctor; but the school was not female friendly in sciences, and my unhappiness negatively impacted my academic success. It caused me to step back and consider a different course for my life — English. Everyone in my family has a degree in English. It’s something that’s been the bedrock of learning for us all, even in a variety of different fields — ministers, doctors, nurses. English was the foundation for learning, but we each went in different directions. I needed to journey awhile before I realized I wanted to pursue nursing. My father had me talk to someone at the local university, which made me realize that I needed to come back to science. It was a journey I needed to take to determine where I should go. TN: Is there a mentor whose advice and support led you to become TNA President? What was that advice? How did it impact you? MDO: Katy Nichols, former TNA President. She was faculty at TCU while I was a student. Katy’s expectation of you as a student was not whether you would join TNA, but how quickly you would join and become involved. TN: What are your top pieces of advice to new nurses? MDO: 1. Relationships are everything — you will need people in whom you can
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confide and seek direction, objective feedback over the course of your career. Nurture those relationships. 2. Always have a contingency plan — ALWAYS. Never assume your first idea will be the best, or that you won’t have to come back around to an alternative idea. 3. Find out what you’re passionate about, and keep it at the core of your career and personal life. 4. Believe in yourself. No one ever encouraged me or helped me get ready for graduate school after earning my BA in English. I had to have the courage and belief in myself that I could succeed. It would be wonderful if we all had mentors. 5. We should all be mentors. Everyone needs someone — mentor, preceptor, friend — who can tell you what they see in you. I think we sell ourselves short and miss out on opportunity to build future leaders. 6. Get involved! TN: How did you get involved with TNA, and how can other nurses get involved with TNA? MDO: I’ve had an unusual love affair with TNA since graduating from TCU. I was president of District 3 just two years out of school. I’ve been on the Governmental Affairs Committee since the late 1980s. I was one of the reviewers for the first “Annotated continued on page 23
MEMBER NEWS
TNA /ANA NEWS AWARDS Cindy Smith, MSN, SN, was voted the 2016 best nurse in Texarkana by readers of Four States Living Magazine. She is an assistant professor of nursing at Texarkana College and “hopes to develop in future nurses the same passion and commitment to patient care that she has possessed for so many years.” Irene G. Rosales, MSN, RN, was inducted into the Laredo Commission for Women 2016 Hall of Fame in April. She is health services director for the United Independent School District and was honored for her work developing comprehensive health services, supplemental health education and a healthy school environment for both students and staff. Fifteen TNA members were named in D Magazine’s Excellence in Nursing Awards 2016. They are:
Stella Apari, BSN, RN-BC, Texas Health Presbyterian Dallas
DeVonn Dillard, RN, Texas Health Presbyterian Hospital Dallas
Dara Mariani, BSN, RN, CCRN, UT Southwestern Medical Center, Dallas
Linda Martin, BSN, RN, Texas Health Harris Methodist Hospital Fort Worth
Deborah Rhoton, RN, CCRN, Texas Health Presbyterian Hospital Dallas
ON THE MOVE
Sharina Arceneaux, MSN, RN, Methodist Dallas Medical Center
Jim Sullivan, MSN, RN, CEN, Baylor Scott & White Medical Center, Carrollton
Salve Chavez Tawaran, RN, Methodist Mansfield Medical Center
Jackline G. Opollo, PhD, RN, Parkland Health & Hospital System, Dallas
Elizabeth Morse, RN, Texas Health Presbyterian Hospital Dallas
Sarah Towery, MS, RN, CCRN-K, Parkland Health & Hospital System, Dallas
Kim Siniscalchi, MSN, RN, FAAN, UT Southwestern Medical Center, Dallas
Elizabeth Ortiz, MBA, BSN, RN, NEABC, Baylor Scott & White Medical Center, Waxahachie
Ruth Robert, RN, CMSRN, PCCN, Baylor Scott & White Medical Center, Garland
Sharon Washburn, MBA, MSN, RN, Texas Health Huguley Hospital, Burleson
Nancy Keenan, MBA, MSN, RN, NE-BC was named by Houston Methodist Willowbrook Hospital in January as its vice president and chief nursing officer. She will lead efforts to advance nursing and clinical practice in addition to serving as Business Practices Officer as the hospital grows and works toward Magnet redesignation from the American Nurses Credentialing Center. Kerrie Guerrero, MBA, DNP, RN, NE-BC, will join Houston Methodist The Woodlands Hospital on July 1 as its vice president and chief nursing officer. She will make the move from her position as vice president of operations at Houston Methodist Hospital, where she has served more than 11 years in various leadership roles. Houston Methodist The Woodlands Hospital will open in 2017. Shelby Garner, PhD, RN, CNE, assistant professor at Baylor University’s Louise Herrington School of Nursing, in February was awarded the Fulbright-Nehru Research Grant from the U.S. India Educational Foundation. continued on page 23
If you are a Texas Nurses Association member and you’ve changed employers, been promoted, received an award, or been elected or appointed to a board or community organization, we’d like to hear from you. Notices printed in the TNA News section are limited to members of the Texas Nurses Association and are printed at no cost. Information must be submitted in writing, is subject to editing, and will be printed as space is available. The TNA News section does not include information on papers, speeches (unless they are of national stature), CNE presentations, or political announcements. Announcements for TNA News should include all pertinent information including employer name, email, and contact numbers. Photos are welcome, but must be 300 dpi (high resolution) at a size of at least 3” x 4”. Send submissions to editor@texasnurses.org.
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UNFINISHED CARE:
RESEARCHER DELVES INTO IMPACT OF NURSE STAFFING CONUNDRUM By Nadia Tamez-Robledo, Texas Nurses Association
This year’s theme for National Nurses Week, May 6-12, focuses on a culture of safety. As defined by the American Nurses Association, a culture of safety is “one in which core values and behaviors — resulting from a collective and sustained commitment by organizational leadership, managers, and workers — emphasize safety over competing goals.” A major component of a culture of safety is allocating appropriate resources, especially staff. More than just a prescribed number of nurses on a shift, safe staffing takes into account the acuity of the patients, skill levels of the nurses, and access to assistive personnel. Texas Nurses Association member Terry L. Jones, PhD, RN, is among researchers who recently examined implicit rationing — when nurses do not have enough time to complete all tasks during a shift and must decide what remains unfinished or passed to the next nurse. Jones’ work provides insight into how staffing impacts the quality of patient care. While unfinished care has been an issue in nursing since before Jones was at the bedside, she believes the nationwide nursing shortage of the 1990s brought the topic into sharp focus. Nurse managers — then and
now — strive for a balance between having enough nurses to provide quality care and being good stewards of resources. “I think everybody was struggling with ‘How many nurses do we need?’”Jones said. “It’s a moving target, even within a shift. [Nurse managers] are charged with providing enough, but nobody can tell them what that is.” First coined in 2005 by Swiss researchers, implicit rationing is “the withholding of or failure to carry out necessary nursing measures for patients due to the lack of nursing resources (staff, skill mix, time).” Jones modified the Swiss survey — measuring 31 items — and collected data from a random sample of 226 registered nurses, licensed vocational nurses, and nurse managers. She presented her research during the American Nurses Association quality-focused conference in March 2016. Measured during a seven-
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... more research on implicit rationing and unfinished care could prove to be a strong indicator of care quality and help nurse managers’ decision-making.
day period, nearly all respondents in the study reported rationing one or more tasks. Thirteen percent said they rationed care “sometimes or frequently.” Because of the time scarcity nurses face, Jones’ research found that nurses prioritize activities that address patients’ immediate health needs over activities that will help keep patients healthy in the future. Nurses reported being less likely to ration tasks such as administering medication and those related to infection control guidelines. Among those most frequently rationed were timely response to patient need or request (five minutes or less), providing patient teaching, and evaluating the plan of care. “They struggle with this,” Jones said of nurses. “They don’t like leaving with things undone for their patients.” Jones said more research on implicit rationing and unfinished care could prove to be a strong indicator of quality, and help nurse managers in decision making. Jones wrote in her findings that additional research is needed to determine if the same negative patient outcomes linked to implicit rationing in other countries also occurs in the United States. According to Jones, the complexity of the issue brings its own challenges to researchers and nurses.
Planning nurse staffing is not like running an assembly line, where the time needed for each task can be neatly added up. “That assumes those things are linear, but that’s not how patient needs present themselves,” Jones said. “Let’s say two patients come back from the OR at the same time. That’s when I then have time scarcity … unless I have someone I can delegate to.” It is not just numbers that impact how nurses’ time is consumed. Workflow and even how people work together as a team play a role, asserts Jones. Nurses, with their different levels of experience and skills, are not interchangeable. If an area is experiencing a nursing shortage, there may simply not be any more nurses to be had. “Because it’s such a dynamic environment, researchers are doing our best,” Jones said, “but we don’t have good measures related to nurse staffing. I don’t foresee a time when we are going to have [more precise] predictors.” While nurses and managers continue to wrestle with the staff formula, Jones recommends two changes in the nurse/manager relationship. The first is to open the conversation with coworkers and managers about what nurses can and cannot realisti-
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cally complete during their shifts. “They don’t want to be seen as ‘less than,’” Jones said. “That conversation needs to happen at shift change. If we have these cultures of safety that everyone wants to have, it would be okay to say that they weren’t able to get everything done. If we know that discharged planning is the most missed [activity] what do we do to boost that? “But the dialogue shouldn’t end there,” Jones added. “[Second,] at the heart of it is really trust between people providing care and people making decisions. If patients trust nurses with their lives, why wouldn’t we trust their judgment about whether or not we need more staff?” i
Readers can learn more about Jones’ research in the following: “A Descriptive Analysis of Implicit Rationing of Nursing Care: Frequency and Patterns in Texas,” was published in the May-June 2015 issue of Nursing Economic$. Unfinished nursing care, missed care, and implicitly rationed care: State of the science review, International Journal Of Nursing Studies, 52 (6), pp. 1121-37; Jones TL; Hamilton P; Murry N (2015).
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BRIDGE TO RECOVERY: TPAPN STRIVES TO RETURN NURSES TO SAFE PRACTICE By Nadia Tamez-Robledo, Texas Nurses Association
For nurses facing substance use or mental health issues, the Texas Peer Assistance Program for Nurses (TPAPN) can help them successfully return to safe practice. “We save lives,” said TPAPN interim director Leanne Bunch, MSN, RN, LCDC, who has been on staff with TPAPN for 18 years. “But the bigger picture is that when one nurse finds recovery, her family begins to heal, then the nurse returns to practice and provides excellent nursing care for the citizens of that community.” TPAPN is non-punitive, voluntary, and confidential for APRNs, RNs, and LVNs with mental health and substance use concerns. A program of the Texas Nurses Foundation, TPAPN was created in 1987 and represents a change in attitude about how nurses struggling with these issues should be treated. “In the past when nurses became sick, we just threw them out,” Bunch said, “or they were terminated and went to work for another facility in the community. This is so much safer.”
“This is not about being a good nurse or a bad nurse. This is about having a behavioral health issue and/or an alleged violation of the Nursing Practice Act. TPAPN provides nurses an opportunity to find recovery.” Nurses come to TPAPN in one of three ways. They can self-refer, be referred by a concerned third party, or be referred by the Texas Board of Nursing. TPAPN participants are assigned case managers and volunteer advocates, some of whom are former TPAPN participants, for support throughout the program. TPAPN offers several programs for substance use issues and two mental health tracks for nurses with mental health concerns. Nurses with mental health concerns and without substance use issues may participate in the year-long Mental Health Support Program, which offers support for nurses when safe practice is not in question. Program requirements include documentation of adherence to prescribed psychotherapy, medication, and possibly drug testing as indicated.
While 71 percent of TPAPN’s participants are facing substance use issues, the remainder are being treated for mental health concerns or both. TPAPN nurses receive support for diagnoses across the mental health spectrum, from depression and anxiety to bipolar disorder and schizophrenia. TPAPN’s eligibility requirements were recently broadened to from accepting only nurses with major depressive disorder, PTSD, schizophrenia, schizoaffective disorder, anxiety disorder, or bi-polar disorder to accepting eligible nurses who may benefit from participation in a peer assistance program.
The second option, the TPAPN Mental Health Track is for nurses with practice issues. It is also one year, carries the same requirements, and includes six months of nursing practice monitoring. Nurses sign a work agreement with their employer, their job is approved by TPAPN, and they adhere to several work restrictions considered appropriate under ADA.
When nurses enter TPAPN, Bunch said, they’re fearful at first. “Nurses come in fighting. They come in tears,” she said. “They’ve worked very hard for their nursing licenses, and we would like for them to see us as here to support them as they stabilize.
TPAPN Case Manager Madeleine Lamarche, BS-CJ, RN, said that participants can feel overwhelmed by information when first entering the program, but case managers are there to walk them through every aspect of their program.
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TPAPN also offers a Dual Track Program for nurses coping with both substance use and mental health issues. RNs and LVNs are required to complete three years in the program while APRNs complete five years.
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MAY IS MENTAL HEALTH MONTH TPAPN’s mission is to offer nurses life-renewing opportunities from substance use disorders and certain psychiatric disorders with the aim of returning nurses back to safe nursing practice, thereby protecting the public and promoting professional accountability. TPAPN is a program of TNF. Learn more about TPAPN services, referral, and how to become a nurse advocate at tpapn.org “We’re here to help them prove to the Board [of Nursing] that they’re quite capable of practicing safe nursing,” Lamarche said. “Nurses are like anyone else who has either a substance use or mental health disorder. They make the same mistakes, and we help them as they discover new ways of making choices.” TPAPN participants are assigned an advocate — a nurse volunteer who offers support and guidance to participants throughout their involvement with the program. (For more information on advocates, please see page 12.) Nurses in recovery learn coping skills, such as how to read subtle changes in their mental health and when to call their therapist or psychiatrist, who can advise them on determining fitness for duty.
Learn how to spot signs of nurses who may be struggling with mental health concerns: Displaying depression, lethargy, lack of focus, apathy Increasingly isolated over time Making an increasing number of mistakes at work Displaying erratic behavior or mood swings Displaying inappropriate or bizarre behavior or speech Having difficulty completing tasks Expressing suicidal ideation/intention
“We wouldn’t want that nurse going to work knowing she’s not 100 percent,” Bunch said. “Our mission is twofold. We want nurses to return to practice, but we want to make sure patient safety is first and foremost.”
NOTE: It is most important to look for patterns or changes in behavior. Not all characteristics need to be present to indicate that a problem exists. Contact TPAPN
Even within the nursing world, stigma against mental health and substance use disorders remain. Bunch said that while progress has been made, more awareness and understanding is needed.
Email: tpapn@texasnurses.org
“We need to do more education with nurse recruiters and employers so they know a TPAPN nurse is closely monitored and very safe,” she said. i
If you are uncertain whether a referral is warranted, contact TPAPN for consultation. TPAPN does not accept anonymous referrals.
Toll free: 800-288-5528 Local: 512-467-7027
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COMMUNICATION SKILLS FOR PATIENT SAFETY:
Speak So Your Message Can Be Heard By Ellen Martin, MSN, CPHQ, RN, Director of Practice, Texas Nurses Association
With ineffective communication being one of the top three causes of sentinel events, effective communication is crucial to addressing patient safety issues. Nurses have a legal, moral, and ethical obligation to take action when risks to patient safety are recognized, yet some nurses are hesitant to voice their concerns. “Speaking up” is defined as addressing patient safety and quality issues when a nurse becomes aware of situations or actions that put patients at risk. A landmark study conducted in 2005 by the American Association of Critical Care Nurses (AACN) involved over 1,700 healthcare team members who participated in focus groups and interviews about chronic problems in healthcare. The study, Silence Kills, revealed some troubling statistics: more than half of the healthcare workers surveyed in this study had occasionally witnessed broken rules, mistakes, lack of support, incompetence, poor teamwork, disrespect, and micromanagement. Many of the safety concerns had been an issue for a year or more and over 75 percent of nurses indicated it was difficult to impossible to confront the individual. The findings were confirmed by a 2010 study, The Silent Treatment, which revealed that the effectiveness of safety tools such as checklists are undermined when
nurses don’t speak up about safety concerns. Nurses may be hesitant to speak up in an effort to maintain harmony and avoid conflict. They may believe that nothing will change or may be uncertain about their ability to speak up effectively. They may be sensitive to power differences and fear retaliation. Developing assertive communication skills can help increase nurses’ confidence. The way safety concerns are brought forward and the language used to describe safety concerns can have a significant impact on how the message is received. This article will review some team-based communication interventions and conflict resolution strategies that nurses can use to effectively communicate safety concerns.
Silence kills
TEAM COMMUNICATION Several team training interventions have been developed to empower nurses to speak up when they believe patient safety is at risk. The Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense Team developed a comprehensive and systematic approach to integrate teamwork into clinical
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practice called Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS™). Based on 25 years of team and culture change research, many of the TeamSTEPPS™ tools and strategies facilitate communication among the healthcare team during patient care interactions to reduce the potential for errors. These strategies include handoffs, call-outs, check-backs, and SBAR communication for conveying critical information that requires immediate attention and action. Additional strategies are recommended for assertive communication when patient safety is at risk. Assertive communication is based on mutual respect and is calm, positive, and objective without being either aggressive or passively accepting of
another point of view. The “Two Challenge Rule” empowers any member of the team to stop whatever is going on if a safety breach is discovered. It is the responsibility of the challenger to assertively voice the safety concerns at least two times to be sure it has been heard. The member being challenged must acknowledge the concern. If the outcome is still not acceptable, it moves up the chain of command. TeamSTEPPS™ also encourages the use of “CUS” words, an acronym for: I am Concerned, I am Uncomfortable, and I feel this is a Safety issue. Team members state their concern clearly, describe why they are uncomfortable, identify how the issue is a safety concern, and then the action recommended. The DESC Script is useful for conflict resolution. This tool provides a template for assertively asking a person to change his or her behavior. DESC is an acronym: Describe the situation, Express the concern, Specify the outcome / S uggest alternatives, and discuss the Consequences.
CONFLICT & COMMUNICATION Sometimes nurses face work situations involving a unit or department issue such as nurse staffing or incivility. In the face of conflict, humans naturally have an emotional reaction. Emotional responses support negative feelings which can spur negative behavior driving a wedge between people, resulting in a cycle of conflict. Once a cycle of conflict is recognized, nurses are in a much better position to address it. Reframing allows a person to view negative emotions as a signal that confirms a legitimate need that has not been acknowledged or satisfied. The cycle of conflict can be broken by engag-
ing others in a safe and respectful dialogue about the issue. The key to open dialogue is creating a safe space for people to speak freely, openly, and honestly. Focusing on mutual purpose and mutual respect can help make people feel safe to openly discuss just about anything. Mutual purpose is the starting place for respectful dialogue and conveys our intent. Conversations can go awry when there is low trust, not because of the content of the conversation, but a belief about malicious intent. Accusations, defensiveness, and circling back to the same points are all signs that mutual purpose is at risk. Mutual respect is vital because once a person feels disrespected the conversation shifts from the mutual purpose to defending dignity. Respect doesn’t mean agreement with another person’s behavior. It is simply honor or positive regard for the other person’s humanity. Contrasting statements can be helpful when mutual purpose or mutual respect is at risk. Contrasting statements address feelings of disrespect (“I don’t mean to suggest…”) and reconfirm the purpose (“I do want to be able to talk about…”). Separating objective facts from subjective opinions and avoiding emotionally-laden words can help maintain a safe space for open dialogue. Sometimes when a safety concern is raised, it may be viewed as a complaint. We can work to reframe a complaint as a signal of what another person cares about. Assuming positive intentions goes a long way to help both parties keep emotions in check and stay focused on patient safety as the goal.
TRIANGLE TALK One simple model for conflict reso-
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lution is called “triangle talk.” Each point of the triangle involves 3 steps. In the first step, the party initiating the resolution figures out what he or she wants, the desired outcome. Step 2 involves finding out what the other party wants and making them feel heard. This involves careful listening to their point of view. These first two steps are the base of the triangle. The third and final step involves reaching up to the highest point of the triangle, the area of common ground. In this step, action is proposed based on the areas of agreement. As the parties discuss their goals, mutual areas of agreement become clearer. Even if it doesn’t appear that way at the beginning of a conversation, there is always common ground. Virtually all healthcare providers can agree that safe patient care is important. The point of triangle talk is to achieve a win-win solution in which everyone’s goals are met, even if both parties have to bend a little to get there. Nurses play a vital role in advocating for patient safety. Learning and practicing assertive communication techniques and negotiation skills can help nurses speak up in a way that their concerns can be heard and lead to positive patient outcomes. i RESOURCES: Crucial Conversations: Tools for Talking When the Stakes are High. K. Patterson, J. Grenny, R. McMillan, and A. Switzler, 2002, NY: McGraw Hill. Getting What You Want: How to Reach Agreement and Resolve Conflict Every Time. K. Anderson, 1993, NY: Penguin. Silence Kills, The Seven Crucial Conversations for Healthcare, available online at psnet. ahrq.gov TeamSTEPPSTM 2.0. Agency for Healthcare Research and Quality available online at ahrq.gov The Silent Treatment, available online at aacn.org
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SOMEONE TO LEAN ON:
TPAPN Advocates Give Back to Nurses in Recovery As told to Nadia Tamez-Robledo, Texas Nurses Association
The Texas Peer Assistance Program for Nurses (TPAPN) serves nurses who are in recovery for mental health and/or substance use issues. Volunteer nurse advocates support and guide participants throughout their involvement with the program.
times treated with stigma. Not by all nurses, but by some.
Nadia Tamez-Robledo of Texas Nursing invited several advocates to talk about their experiences serving as an advocate. Their stories are below.
“Can you imagine if someone’s drowning, and you’re able to help pull them out of the water and they survive? That’s what it’s like being an advocate or case manager. Because that’s how we get our nurses; they’re drowning. Can you imagine how rewarding that is?”
Cathy Reinermann, RN, LCDC, is a former TPAPN case manager coordinator who has been a volunteer nurse advocate for nearly 15 years. “Usually the attitude of nurses coming into the program is extreme denial that there’s a problem and a lot of maybe anger and frustration. A lot of fear because they feel like they’re going to lose their profession and their livelihood. We always say, ‘At first I did recovery because I had to, but when I get out of TPAPN, I do the same things because I want to.’ Recovery becomes a way of life. You see nurses go from anger and fear to gratitude. “If a nurse has to go on leave because they have breast cancer and they come back, they’re greeted with open arms. If a nurse is out because of, say, treatment for bipolar disorder or major depression or chemical dependency, it’s some-
That’s why I think TPAPN’s role is vital — they do a lot of education. Working with the Board [of Nursing] and TNA though all the years, I’ve seen education is the key.
Leonard Keesee, RN, LCDC, NCAC II, was part of the 1983 TNA Task Force on the Impaired Nurse, the original committee for the eventual creation of TPAPN. “I’m an addict and alcoholic. By the time I got recovery, I’d been fired from every major hospital in Dallas — there are six of them. I’ve been an advocate ever since, and in a sense I’m giving back. “Any addict, they’re full of shame. You take a nurse who’s an addict; you multiply that shame about 20 times. When I first got clean, I thought I was the first nurse who’s ever done it. Every nurse that enters my office, they feel the same way. “I think [TPAPN advocates] are important because that’s a lo-
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cal contact. I love our [staff] case managers, but they’re a voice on the phone … your advocate can sit down and talk to you. “There’s one [participant] in particular who is now an advocate. To say that she hated my guts when we first met is putting it mildly. She’s been an advocate now for 12 years, and when we have TPAPN workshops she says, ‘I’m an addict, and I’m here because Leonard saved my life.’ Did I actually save her life? No, we each do that. “When a nurse gets into recovery, it’s not that they don’t like themselves. They hate themselves. And you’re there saying, ‘I believe in you. I know you can do this.’ Especially for a nurse, if we’re going to get better, we’ve got to forgive ourselves.” Barbara Mitchell, RN, has been a TPAPN nurse advocate since 1988. “I stared working in psych mental health in 1972. I always found it interesting when people would have a relative or someone admitted to the local hospital, if the diagnosis was alcoholism, they felt it was less shameful than having a mental illness. “To me, there’s an interesting phenomenon that happens. During the first few months of participation, it’s such a life-changing thing for them. Most of them come into the pro-
our nurses away because this is a disease process. “When they come in, they’re angry because they’ve had to give up their coping mechanism. They think they’re never ever going to have any fun anymore. They don’t like the meetings we ask them to go to because it’s all about people who are sober. Part of my job as an advocate is to convince them their life is going to be better than it ever has been if they enter this simple program. “The biggest gift is when they graduate, they become an advocate, and 20 years later they’re still in as advocates. “As nurses we are at the bottom of the list because we want to take care of others before we take care of ourselves. That’s the message to new nurses coming in: Where are you on your list?
Can you imagine if someone’s drowning, and you’re able to help pull them out of the water and they survive? That’s what it’s like being an advocate. gram confused because it’s such a change in their way of thinking and performing. Sometimes the person they get angry at is their advocate. “After they get over that initial shock phase, they have this ‘a-ha’ moment, and you can tell just by the tone of their voice or their presentation, even on the telephone. They’ve realized this is no longer an intellectual exercise. They own it completely, and it’s almost like this huge relief. I live for those a-ha moments. “I retired three and an half years ago, and I keep my license because
“The bottom line is I firmly believe that TPAPN saves lives and that advocates are so instrumental. If we came into nursing because we wanted to save lives, here’s your opportunity. It’s the advocate that gets the gift as much as the participant.”
of TPAPN.” Shirley Baugh, BSN, RN, graduated from TPAPN in 1994, is a long-time nurse advocate, and formerly served as an advocate coordinator. “Whenever I was ready to graduate from the program, there was a voice in my head that said, ‘You’re not being monitored anymore.’ And I recognized that voice as the voice of my disease. “Although you do not have to be in recovery to be an advocate, this is a way we give back to our nurses. I believe we do not have to throw
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Bronwyn Schielke, BSN, RN-BC, specializes in psychiatric, mental health, and med-surg nursing. She has been a TPAPN nurse advocate for four years. “I was really interested in trying to help nurses that were impaired because my sister was an alcoholic. She wasn’t a nurse, but she committed suicide. I wanted to help nurses in the workplace escape the way alcoholism progresses. “I was a stay-at-home mom and went back to college in my 40s, and I’ve been a BSN nurse for 26 years. The reason I became a nurse
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Especially for a nurse, if we’re going to get better, we’ve got to forgive ourselves. is because of my sister. I thought if I learned enough, I could keep her from drinking. I learned right away you can’t keep anyone from dinking, but being supportive of someone may help them stay sober. “There are many things they have to do, and they start out a little bit overwhelmed, but they seem to appreciate having someone to checkin with and having someone to be accountable to. I’ve helped I think six nurses at this point, and I’ve got an assignment of three now. They all have plans to come in and be advocates themselves.
“It’s very important the general nurse population knows you do not have to be in recovery to be an advocate. “It’s very personally satisfying to know that you’ve helped someone. I’ve been very blessed in that all the nurses I’ve had have successfully completed the program, are in the workforce, and are doing well.” i
HELP A NURSE IN NEED: CONSIDER BECOMING AN ADVOCATE TPAPN is actively recruiting nurses to give their time to help support fellow nurses struggling with mental health issues and/or addiction. For more information on TPAPN’s purpose and activities, please see page 8. TPAPN advocates are invaluable liaisons between the nurses enrolled in the program and the staff case manager. Advocates work as a much-needed regional support network for TPAPN by communicating with program participants and providing resources or assistance as needed. Advocates help facilitate an understanding of the program and create a bond that will support and benefit nurses in need across the state of Texas.
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To be a volunteer advocate for TPAPN, your Texas nursing license should be current and unencumbered. Participating as an advocate requires a commitment of approximately two hours per month. TPAPN will ensure you have all necessary tools and resources by providing Advocate Workshops in Austin twice per year. To apply to become a TPAPN advocate, complete the advocate application at tpapn.org and click on “Advocate Application” under “Volunteer with TPAPN.” For any questions, please email tpapn@ texasnurses.org or dglover@texasnurses.org.
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PROBING MENTAL HEALTH AT THE STATE CAPITOL By Andrew Cates, JD, Director of Government Affairs, Texas Nurses Association
In late 2015, the Texas Legislature jumped back to life after months of dormancy since the end of the 84th legislative session. The new life came from “interim charges” — issues the Speaker of the House and Lieutenant Governor would like the legislative committees to hold hearings on in the year leading up to the next legislative session. Usually, interim charges offer a glimpse of what is to come in the next session by providing a sneak peek into the minds of top lawmakers and what they want to understand better before filing bills. This time around, the interim charges were laden with references to mental health — funding, quality and timing of care, state hospitals, safety, and the criminal justice system. Multiple committees received charges on mental and behavioral health, and the capitol is abuzz with mental health issues for the first time in a while. The renewed life around mental health issues means that TNA has yet another avenue to engage members and the legislature through the new Mental Health Workgroup. TNA quickly created this workgroup to address policy issues pertaining to mental and behavioral health nurses so we can ensure that nursing is not lost in the broader conversation about mental health.
The renewed life around mental health issues means that TNA has yet another avenue to engage members and the legislature through the new Mental Health Workgroup. The workgroup is already hard at work developing policy positions and making recommendations so that the Policy Council can synthesize them into the TNA Policy Book in June. Keep an eye out for the Policy
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Book on the TNA website by late July/early August. i
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BOARD OF NURSING FACES SUNSET: WHAT DOES THAT MEAN FOR YOU? By Andrew Cates, JD, Director of Governmental Affairs, Texas Nurses Association
When you think of sunsets, you probably imagine sitting outside looking at pink and orange skies and thinking “how pretty.” But when facing the sunset process for state agencies in Texas, I assure you, it’s not pretty. Every state agency in Texas, including the Board of Nursing, must go through what’s called a “sunset process” every seven years. The process is a sort of internal and external audit of the agency by the Sunset Review Commission, which includes public and legislative members looking at agency budgets, operations, licensing fees and structure, and disciplinary process. During this audit, the Commission decides whether any changes are needed in the agency, including whether or not it should even exist … thus, sunsetting the agency, or shutting it down. However, this has only happened a couple of times in the last few decades.
HERE’S HOW IT WORKS: 1. Sunset staff performs extensive research, speaks with interested stakeholders to evaluate the need for improvements to the agency, and develops recommendations. 2. Then Sunset staff publishes a Staff Report which contains all of its recommendations about changes to the agency. Public hearings
are held to discuss the report and receive public input. The report is changed based on input. 3. The final product from the Sunset Commission is the Sunset Report, which is a culmination of staff, stakeholder, and public recommendations on changes needed for the agency. The final report is turned into a legislative bill which is introduced and goes through the same process in the capitol as other bills to become law. The process from inception to passage of a sunset bill takes over one year and involves dozens (if not hundreds) of people working to make sure that the agency is thoroughly vetted and that necessary changes are made to ensure that the government’s budget is being spent efficiently.
ANSWERS TO FAQS REGARDING THE BOARD OF NURSING AND SUNSET: 1. Can the Board of Nursing’s audit have any real impact on me as a nurse? It depends on what happens. If the Sunset Commission picks around the edges and only makes slight tweaks to internal operations at the Board, the answer could be, “not really.” But imagine if the legislature
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reduces funding for the Board, or decides that the disciplinary process isn’t tough enough on nurses, or that the Board is duplicative and that all health professions should be under the Texas Medical Board? That could have a very big impact. That’s why it’s important to keep an eye on it and stay active in the process. 2. Should we be worried that the Board of Nursing will be “sunsetted” and won’t exist anymore? No. This is an ongoing process for all state agencies and only a few agencies have ever been sunsetted, one because of rampant corruption and mismanagement and another because it was no longer needed. Barring something catastrophic happening, the Board of Nursing won’t be going anywhere. 3. What’s the timeline for the Board’s sunset process? The Board of Nursing’s sunset will begin in May and will continue through the summer until around September. Private stakeholder comments will be solicited in May and June, and the public hearings will occur sometime during the summer. 4. Will TNA be involved in the Board of Nursing’s sunset? Intimately. This is our Board, and our members need to know exactly
This is our Board, and our members need to know exactly what is happening with it. TNA will be there every step of the way to make sure that the Sunset Commission makes helpful recommendations to the legislature.
what is happening with it. TNA will be there every step of the way to make sure that the Sunset Commission makes helpful recommendations to the legislature. We’ll be on the ground at the capitol every day to ensure that the Board of Nursing bill is taken care of.
5. What if I have recommendations for something that I think should change with the Board? You have two options — you can either email them to Andrew Cates, TNA’s Director of Government Affairs at acates@texasnurses.org, and TNA
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may include them in the association’s comments as a stakeholder, or you can come to Austin for the public hearings sometime this summer and present them yourself. TNA will keep members informed on the details of the hearings. i
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TNA DELEGATES CELEBRATE NURSING AND TNA By Cindy Zolnierek, PhD, RN, Executive Director, Texas Nurses Association
Close to 150 delegates representing 22 TNA districts met on April 16 for the annual House of Delegates. First held in 1980, the TNA House of Delegates includes individuals elected or appointed by districts to represent their members at the annual meeting. Delegates are the ultimate decision makers on governance of the Association, voting on resolutions, changes to the bylaws, and electing representatives (new this year!).
RIVETING SPEAKER LEADS SALONS This year’s House opened with Marie Manthey, PhD (hon), MNA, FAAN, FRCN, known to many as the “mother of primary nursing.” Manthey introduced herself with a poignant story of being a hospitalized child at a time when parents were allowed only an hour or so of visitation each week. Feeling confused and alone, her world changed when a nurse colored in her coloring book – a simple act that established a connection, a nurse-patient relationship. From that point on, Manthey knew that she would be a nurse, a nurse that connected and related to her patients. This experience, this memory, was the foundation of her groundbreaking work in primary nursing and relationship-based care. Driving home the importance of relationship, Manthey repeatedly emphasized, “Relational incompetence is no more tolerable than clinical incompetence.”
A recovering nurse herself, Manthey’s latest work has focused on establishing peer support networks in her home state of Minnesota for nurses with substance use issues — following an inspiration from her participation in TPAPN’s Advocacy Workshop in 2013. She is also very involved in facilitating Nursing Salons — a process she describes as “a group of nurses engaging in thoughtful conversation about the nursing profession. It is an opportunity for nurses to connect — across specialties, practice environments, hierarchies, roles, etc. — and discuss nursing.” The resultant conversations are powerful: “Conversations change people, and people change the world,” said Manthey. She then facilitated a mass Nursing Salon among the HOD attendees. Participants were assigned random seating to enhance diversity of conversational groups. Marie provided simple instructions for the Salon: Check In: roundtable providing everyone an opportunity to answer the question: What is on your mind about nursing? Conversation: groups discuss topics that pique their attention Check Out: groups identify how they are feeling/thinking following the discussion This was the first time a Nursing Salon had been conducted with a large
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group. Judging from the anecdotal feedback of participants, conversation was meaningful and rewarding. Watch for information on the district resources site to help you begin sponsoring Nursing Salons!
DELEGATES CONDUCT BUSINESS The House of Delegates convened to conduct association business in the afternoon. Policy Council Chair Jeff Watson, MSN, RN, CRRN, NEABC, reported on the work of Policy Council and its committees (Workplace Advocacy, Education, Regulation, APRN, and the Mental Health Workgroup). Over 40 TNA member volunteers serve on Policy Council committees, and an additional 469 members serve as expert advisors to those committees. The TNA Board will respond to Policy Council recommendations this summer in preparation for the next legislative session. President Margie Dorman-O’Donnell, MSN, RN, is TNA’s longest serving president (five years) and led the association through some of its most significant changes. She reflected on these events during her address (See page 4 and 22 for an interview and timeline of her presidency.) Executive Director Cindy Zolnierek, PhD, RN, challenged delegates with a “call to action.” No longer are we visioning, journeying, imagining, or meditating on our navels. We are
FROM LEFT: Cindy Zolnierek (left) presents Certificate of Service to TNA President Margie Dorman-O’Donnell; Pam Lauer is presented with the Friend of Nursing Award; TNA delegates, staff, and board members conduct nursing salons prior to the House of Delegates business meeting.
actively implementing a strategic plan to achieve the objectives of TNA Renewal – an effort that requires the alignment and commitment of every district with the strategic goals. (See inset.) Delegates approved proposed bylaws changes related to filling vacancies on the TNA Nominating Committee and reinstating a proviso on organizational/affiliate membership pilot programs. A resolution on fatigue proposed by the Workplace Advocacy Committee passed unanimously. Pam Lauer, the Director for the Texas Center for Nursing Workforce Studies (TCNWS), was honored with a Friend
of Nursing Award for her efforts at TCNWS. This was the first year for elections to be held at the House of Delegates per policies adopted to implement TNA Renewal. Delegates elected members of the Nominating Committee: Susan Ramnarine-Singh, EdD, RN, MSN, MPA Patricia G. Francis-Johnson, DNP, RN Colleen Marzilli, PhD, DNP, MBA, RN-BC, APHN-BC, CNE Those assuming elected positions were installed by President DormanO’Donnell (Nominating Committee members as well as Jeff Watson, incoming president, and Kim Belcik,
HIGHLIGHTS OF APRIL TNA BOARD MEETING The day before the House of Delegates convened, the TNA board of directors held their quarterly meeting, making the following decisions:
Approved the TNA Advocacy Assistance Fund policy to address requests from nurses asking for support or direct assistance in pursuing remedies related to patient advocacy activities. Adopted the TNA Volunteer Member policies to govern volunteer positions such as committee and board members — as well as members appointed to external committees on behalf of TNA — in relation to attendance, intellectual property, conflict of interest, and confidentiality.
Appointed Jill Henry, MSN, RN, ACNS-BC, and Candice Lynn WardHerman, MSN, RN, NEA-BC, to the CNE Committee.
Agreed to purchase a table at the J&J Promise of Nursing Gala.
Appointed Jennifer Cook, PhD, MBA, RN, to serve as chair of the Nominations Committee, effective immediately through June 30, 2018.
incoming vice president). The installation included an inaugural Presidential pin. President DormanO’Donnell is the first recipient and was pinned by Executive Director Zolnierek. President DormanO’Donnell then pinned Presidentelect Watson recognizing his future role in leading the association. i
TNA STRATEGIC PLAN At the House of Delegates, Executive Director Cindy Zolnierek, PhD, RN, shared TNA’s strategic plan, which includes the following goals: Strengthen districts through enhanced services and accountability. Aggressively grow membership by acquiring, engaging, and retaining members. Advance the quality and safety of patient care through policy initiatives that optimize professional practice, advance positive practice environments, and promote full use of the knowledge and skills of nurses. Exploit opportunities to maximize financial value of TNA.
The board members were also given an update on the TNA strategic plan and the progress of the Policy Council.
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NURSING’S LEGACY HONORED THROUGH TNA Close to 200 people gathered in mid-April at the Westin Hotel in Austin to celebrate the impressive individuals who have helped build the nursing profession in Texas.
held during the reception for baskets donated by TNA districts.
The following individuals were honored with the 2016 Legacy Awards: Dolores Alford, PhD, RN, FAAN Mary Fenton, DrPH, RN, ANP, AHN-C, FAAN Sister Charles Marie Frank, RN* Renilda Hildemeyer, RN* Ellen Palmer, PhD, RN Mildred Primer, RN* Jim Willmann, JD
Dolores Alford, PhD, RN, FAAN, helped establish the care of the elderly focusing on wellnes promotion. In the early 1970s, Alford participated in a study which recommended several improvements for nursing homes, including written standards. She also developed the gerentological nurse program at Texas Women’s University. One of the first graduates of the program, Janet Moll, joined Dolores to open the first independent nursing practice in Texas. Alford served on the TNA board of directors and was active in District 4.
*Honored posthumously
The proceeds of the Legacy event benefit the Texas Nurses Foundation, which supports the Texas Peer Assistance Program for Nurses, Texas Team Action Coalition, and Academic Progression in Nursing RWJF Grant. The newest program funded through the Foundation is the Nursing Policy Dissertation Research Grant program, which will support research specifically relating to policy initiatives supported by TNA. Launched earlier in the year by a $10,000 pledge of TNA Executive Director Cindy Zolnierek, the fund needs $30,000 as a solid base for at least one $5,000 to $10,000 grant annually. Through the generosity of the attendees, $6,700 was raised at the event benefitting the Texas Nurses Foundation. This included a raffle
The seven Legacy honorees have each made significant contributions to nursing:
A visionary in nursing education, Mary Fenton, DrPH, RN, ANP, AHN-C, FAAN, believed that if nurses could be prepared at an advanced level, they could make a more significant contribution to health care. She served as dean of the University of Texas Medical Branch School of Nursing for 15 years. An advanced practice holistic nurse, Fenton was the driving force behind the development of UTMB’s doctoral program in nursing with a focus on healing. She also served as the director/founder of the Doctor of Nursing Practice program for Texas Tech University, and presi-
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dent of the Texas Board of Nursing. Ellen Palmer, PhD, RN, is a tenacious advocate for her patients, whether those patients reside in Texas or in Haiti. For the past 35 years, Palmer has visited Haiti and the Dominican Republic multiple times per year to bring clothing, donations, and quilts to the children. She also trains nursing staff at Grace Children’s Hospital in Port au Prince and has raised tens of thousands of dollars for the hospital. A former board member of the Texas Nurses Association, she spent much of her career as an emergency room nurse at Wichita General Hospital. For 40 years, Jim Willmann, JD, served the nurses of Texas. Jim firmly believed that nurses should be at the forefront of developing policies affecting nurses and their patients. If nurses sat on the sidelines, policy development would still occur, just not necessarily in the best interest of nurses or patients. By determining the best legislative solution to issues like staffing, safety, and patient handling, Willmann passionately defended Texas nurses and their patients. His development of safe harbor peer review provided nurses with the processes to protect patients and themselves. Renilda Hilkemeyer, RN, was the first Director of Nursing at what is now University of Texas MD Anderson
Cancer Center. She helped transform care for cancer patients by developing recovery rooms, surgical intensive care units, and an outpatient clinic for chemotherapy. She created teaching guidelines on how to perform intravenous therapy and chemotherapy, built triangular units for nurses to monitor patients, established a rehabilitation unit; and built a child care center for the Houston Medical Center, She also served as president of the Texas Graduate Nurses Association (now Texas Nursing Association). Mildred Primer, RN, believed strongly in the important role of public health nurses. She became Potter County’s first public health nurse, and in 1943, Primer took the position as the first Texas State Director of Public Health and Nursing, a post she held until 1972. That placed her as the highest ranking female employee in state government. Primer also designed the public health curriculum for the West Texas State University School of Nursing and served as president of the TGNA (now TNA). Sister Charles Marie Frank, RN was a devoted nurse and educator. In the 1940s, Sr. Charles moved nursing from apprenticeship training to professional education by creating a baccalaureate nursing program at Incarnate Word College. Sr. Charles served as president of the TGNA (now TNA) and as the second dean of the Incarnate Word School of Nursing. In 1964 Sister Charles Marie and her fellow sisters established a mission to help thousands of displaced and impoverished Indians in the desert area of Chimbote, Peru. It still thrives today. Congratulations to the 2016 Legacy honorees, and thank you to everyone who participated in the Legacy Banquet! i
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Photos by Carol Smith 1. (from left) University of Texas faculty Sara Rechis, Carol Delville, Gayle Acton, Leigh Goldstein, Gendy Joiner-Rogers, and Terry Jones celebrate nursing; 2. TNA District 17 President Cindy Keese (left) with TNA board member Pam Greene; 3. 2016 Legacy honoree Ellen Palmer encourages banquet attendees to join her in the Hotter’N Hell bicycle ride to raise money for Grace Children’s Hospital in Port au Prince, Haiti; 4. Texas Nurses Foundation President Jeff Watson addresses the crowd of almost 200 people. 5. (from left) The 2016 Legacy honorees Jim Willmann, Mary Fenton, Ellen Palmer, and Dolores Alford; 6. (from left) TNA Director of Government Affairs Andrew Cates with District 9 President Robert Blake and Marco Ollervides
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MARGIE’S LEGACY
2011 – 2016: MARGIE DORMAN-O’DONNELL LEADS TNA THROUGH TRANSITION
2011 – 2012
SUMMER 2011 > Margie Dorman-O’Donnell, MSN, RN, assumes TNA presidency; TNA becomes co-sponsor of Texas Team Action Coalition
2012 – 2013 < SUMMER 2012 FALL 2012 > Decision made to relocate TNA offices
Long-serving executive director retires; Interim ED appointed
< SPRING 2013 Decision made to participate in pricing pilot with ANA; Legislative wins: Enhanced advocacy protections, penalties for assault against nurses, APRN practice; The office of secretary/ treasurer is separated into two offices
2013 – 2014 SUMMER 2013 > Board adopts values for the association: RESPECT, INTEGRITY, EXCELLENCE, COURAGE, DIVERSITY SPRING 2014 > House of Delegates: Engages in a World Café to reimagine TNA
< FALL 2013 Pricing pilot exceeds expectations; New executive director named
2014 – 2015 < FALL 2014 SPRING 2015 > Legislative win: Workplace violence study; Directors of finance and governmental affairs retire; Inaugural Legacy Banquet; House of Delegates: Approves TNA plan for renewal, Revises election process; Participates in Future Search to celebrate past and envision future
Prominent exterior sign on building signifies TNA presence
2015 – 2016 FALL 2015 > TNA assumes leadership position in establishing new APRN Alliance
TODAY > “Never doubt that a small group of thoughtful, committed people can change the world; indeed it is the only thing that ever has.” — Margaret Mead
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< SUMMER 2015 Board adopts Strategic Plan based on TNA Renewal; Board appoints inaugural TNA Policy Council; Board revises mission statement; Districts begin transition to integrated or supported status; NOEP concludes operations
< SPRING 2016 House of Delegates: Participates in Nursing Salons with legendary Marie Manthey, elects Nominating Committee
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TNA/ANA NEWS continued from page 5
The grant will provide her the opportunity to research the impact of simulation education in nursing curricula in Bengaluru, India. More than 2.4 million nurses are needed to fill the nursing workforce gap in India, according to the World Health Organization.
Ray Kelly, MSN, RN, has been named chief nursing officer of Texas Health Harris Methodist Hospital Hurst-Euless-Bedford. Previously, Kelly served as CNO of Texas Health Presbyterian Hospital Plano. Karen Myers, MSN, RN, NEA-BC has been named vice president/chief nursing officer of Memorial Hermann – Texas Medical Center. Previously,
Myers served as VP/CNO of CHI St. Luke’s Health – Baylor St. Luke’s Medical Center.
ELECTIONS/APPOINTMENTS Cole Edmonson, DNP, RN, was recently named as a trustee of the Texas Hospital Association board. Edmonson is the Chief Nursing Officer for Texas Health Presbyterian Hospital Dallas. i
PRESIDENT’S NOTES continued from page 4
Guide for the Nursing Practice Act.” I was chair of the task force looking at David Marx’s work and Just Culture (of Safety). People who were intimidating were brought together as members of that task force. From the work of that group of individuals came a successful legislative effort to revise the Nursing Practice Act and direct the Board of Nursing to perform a system review of an untoward patient outcome instead of focusing blame on the individual nurse. I was fortunate to transition from the GAC to the board as first vice president then president. Nurses need to be more unified in our support of each other. TNA has been one of those opportunities where I have been able to find professional completion in being part of the process to affect nursing practice, policy, and health policy. I have been fortunate to be able to turn to previous presidents for advice and support. TNA can be that for anyone, but we have to actively nurture that environment/culture. I think we do have a culture of inclusion at the local level. Everybody doesn’t do it the same way. We have to embrace our uniqueness and our differences to expand the nursing profession. TN: What superpower would most
help you in life? MDO: To know whether someone is being truthful. TN: What’s the best trip you’ve ever taken and why? MDO: I went with my mother to the Far East. It was sponsored by our church, and we got to see things like refugee camps that usual tourists wouldn’t see. We found it extremely rewarding. TN: Any last thoughts or thank yous? MDO: Nursing Faculty at TCU and UTA have been instrumental in my development as a nurse. The access to former presidents has been critical to feeling supported and guided. I’ve appreciated the open trust and dialogue I’ve enjoyed with Cindy. I thank the many nurses with whom I’ve had fun working with as a nurse — a lot of good times, some wicked humor in patient care. I thank lifelong friends, one of whom is a missionary in Cameroon today, but I met at TCU and remain in contact with. There are not adequate words to express the appreciation I have for the TNA staff. I have been guided by staff — Jim [Willmann], Belinda [Richey], Julia [Menegay], Clair [Jordan], and Margaret [Hobbs]. I have
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tremendous respect for Jim. No one will ever know the steady rock and hand that Julia was throughout the staff transitions; quietly supportive, assisting from the sidelines. Sweet Cheryl [Kee] always takes my calls and finds the person I’m calling. Throughout my term and especially during the transition, I was in Austin often three times in one week. I thank Cook Children’s Medical Center’s upper management, who provided support and time to participate in the way in which I have participated. Almost half of my tenure at Cook Children’s, I have been on the board of TNA — vice president then president. This would not have been possible without my employer’s support and approval. One other person I would be remiss if I did not acknowledge is Louise Golden, my office manager for Case Management at Cook Children’s Medical Center. She has been my right-hand person in making sure I made all my commitments — meetings, articles, presentations! Without her assistance, I would never have been able to have met all my deadlines! I wish Jeff [Watson], the board of directors, TNA staff, and membership the brightest of futures, for indeed I do believe the best is yet to be. i
T E X A S N U R S I N G M AGA Z I N E | S P R I N G 2 016
8501 North MoPac Expressway Suite 400 Austin, TX 78759-8396
BEYOND THE CAPITOL WHERE IS TNA REPRESENTING YOU? The Texas Nurses Association’s advocacy for nurses and the profession extends far beyond the Texas Capitol. Look at where you were represented in the last quarter!
TEXAS TEAM: ADVANCING HEALTH THROUGH NURSING
AMERICAN NURSES ASSOCIATION
Advancing Education Committee
Health Policy conference call
J&J Gala Steering Committee
Nurses on Boards Coalition State Strategy
AARP Progress on IOM Recommendations Executive Committee and Regional Nurse Leaders Committee Joint Meeting
Development planning conference Nursing Practice and Work Environment conference call
Texas Team Strategic Advisory Committee, Dallas
President/ED conference call
BOARD OF NURSING
AMERICAN ACADEMY OF NURSING
BON Workforce Data on Texas Nurses Quarterly meeting with Kathy Thomas TEXAS HEALTH AND HUMAN SERVICES State HHS Committee on Mental Health Texas Center for Nursing Workforce Studies Advisory Council Texas Center for Nursing Workforce Studies, RN Mobility in Rural Communities Texas Public Health Action Plan Steering Committee Behavioral Health Advisory Council (Member Celeste Johnson, DNP, RN) Texas Preparedness Coordinating Council (member Ron Hilliard, MSN, RN)
TEXAS ASSOCIATION OF DEANS AND DIRECTORS OF PROFESSIONAL NURSING PROGRAMS NURSING SHORTAGE REDUCTION APPROPRIATION MEETING APRN ALLIANCE APRN Legislative Day at the Capitol TEXAS ALZHEIMER DISEASE PARTNERSHIP MEETING TEXAS ORAL HEALTH POLICY WORKSHOP TEXAS COALITION FOR HEALTHY MOTHERS AND BABIES TEXAS PUBLIC HEALTH COALITION Public Health Capacity Workgroup