Texas Nursing Magazine - Winter 2017

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TEXASNURSING M A G A Z I N E HEALTHY NURSE

HEALTHY NATIONâ„¢ HEALTHY COMMUNITIES START WITH NURSES

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 | W i n t e r 2 0 1 7

WINTER 2017 Volume 91, Number 1 EDITOR-IN-CHIEF: Cindy Zolnierek, PhD, RN MANAGING EDITOR: Kat Hinson 8501 North MoPac Expressway, Suite 400, Austin, TX 78759-1292 P: 800.TNA.2022 or 512.452.0645; F: 512.452.0648 tna@texasnurses.org | texasnurses.org

MISSION Empowering Texas Nurses to advance the profession

BOARD of DIRECTORS OFFICERS:

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

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

Terry Throckmorton, PhD, RN, Secretary

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

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

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

Pam Greene, PhD, RN, South

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

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

Cindy Zolnierek, PhD, RN

TNA DISTRICT AND PRESIDENT

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

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

Subscription is not available to non-member Texas nurses.

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

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. POSTMASTER Send address changes to TEXAS NURSING, 8501 North MoPac Expy., Suite 400, Austin, TX 78759-8396 ARE YOU MOVING? Need to change your address? If so, provide it quickly and easily in the Members Only section of the TNA web site, texasnurses.org. Or mail us your new address — at least six weeks prior to your move — to Texas Nurses Association headquarters. We’ll make sure your TEXAS NURSING makes the move with you.

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

Dist.1:

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

Dist. 2: Sharon Brewer, 806-414-9336, sharon.brewer@ttuhsc.edu Dist. 3: Elaine Nelson, 682-518-0819, elainenelson@texashealth.org; District office: 817-249-5071, tna3@usapathway.com, tna3.org Dist. 4: Jeanie Zelanko, 972-270-4691, zelanko@sbcglobal.net; District office: Pat Pollock, P.O. Box 764468, Dallas, TX 75376; 972-435-2216; d4tna@flash.net; tnad4.org Dist. 5: Matthew Davis, 413-841-1319, MatthewDavisRN@gmail.com, tna5.org Dist. 7: Naomi Devers; District office: P.O. Box 132, Belton, TX 76513, tnadistrict7@gmail.com Dist. 8: Linda Juenke, 830-739-7028, ljsoaringeagle3@gmail.com Dist. 9: Cheryl Lindy, 281-883-8229, cmlindy@earthlink.net; District office: Melanie Truong, 7324 Southwest Freeway, Suite 2-1453, Houston, TX 77074; 713-523-3619; tna9@tnadistrict9.com; tnadistrict9.com Dist. 10: Anita Farrish, 254-421-9797, anitafarrish2001@yahoo.com Dist. 11: Daria Close, 940-867-1134, daria.close@mwsu.edu Kathleen Williamson, 940-397-4610, Kathleen.williamson@mwsu.edu Dist. 12: Heidi Wolf, 409-853-5900, HWolf@iasishealthcare.com Dist. 13: Nannette Kelley, nannettekelley@msn.com Dist. 14: Eloisa Tamez, 956-882-5079, eloisa.tamez@utrgv.edu Dist. 15: Andrea Kerley, 325-670-4230, akerley@hendrickhealth.org Dist. 16: Holly White, 325-656-0231, holly.white@cookchildrens.org Dist. 17: Cindy Keese, 361-332-1643, cakeese@aol.com Dist. 18: Pat Francis Johnson, 806-743-2730, ext. 237, patricia.francis@ttuhsc.edu Dist. 19: Karen Koerber-Timmons, 903-452-3004, ktimmons@uttyler.edu Dist. 20: Deborah Peña, 361-570-0356, debbie.pena@victoriacollege.edu Dist. 21: Jessica Tully, 432-254-1949, jessica.tully@midland-memorial.com Dist. 22: Toni McDonald, 936-544-8823, t.mcdonald323@yahoo.com Dist. 26: Elizabeth Adamson, 956-362-3015, e.adamson@dhr-rgv.com Dist. 28: Jessica Smallwood, 903-280-2071, jessicasmallwood@me.com Dist. 35: Chrystal Brown, 903-434-8302, cbrown@ntcc.edu Dist. 40: Contact TNA, 800-862-2022, ext. 129, brichey@texasnurses.org

Copyright 2017 © Texas Nurses Association

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Printed on Recycled Paper

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HEALTHY COMMUNITIES START WITH NURSES

NUTRITION SAFETY REST

FATIGUE.

PHYSICAL ACTIVITY

QUALITY OF LIFE

STRATEGIES TO HELP

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8 ADVOCACY:

DELIVERING A POWERFUL MESSAGE

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PRESIDENT’S NOTES

2017 TNA BALLOT ANNOUNCED

Walking Each Other Home

TNA Candidates for Board/ Nominations Committee

SUPPORT YOUR DISTRICT AT THE 2017 HOUSE OF DELEGATES

FINAL RECOMMENDATIONS ADOPTED BY THE SUNSET COMMISSION

6 TNA MEMBER NEWS Kudos, Elections & Appointments

Join Us April 28 – 29

How You Were Represented and What’s Next

TNA ELECTION: April 29 at the 2017 TNA House of Delegates

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

WALKING EACH OTHER HOME Guardians of the Stories that Chronicle Humanity WHEN I WAS A MUCH YOUNGER MAN, over the Christmas holidays in the early 1970s, we moved to a new town. With the new environment and the new schedule, both of my parents instructed me to walk my sister home every day after school. I remember the words that reinforced how important this new routine was, “she’ll be lost, and she needs you to find the way home.”

As we walked together, we knew that we were fated to stand outside the ring of social norms because ultimately we would accept those boundaries and try hard to avoid being branded, as we were pushed further and further into the margins. You see, different doesn’t fit. However, different will find different — and when that happens, they walk each other home.

And so I did as I was told because I was, even from a young age, a chronic rule follower. Every day after school, I walked her home.

One day we stopped walking, we began driving. What freedom! We drove, and we drove around the same threemile stretch of town. Whether behind the wheel or riding shotgun, we were still walking each other home. By this time, others who were different joined us — and somehow, we found new ways to walk home … together.

So, what was central to the conversations of a fourth grader and first grader?

Glue, usually: Elmer’s Glue. She was always telling me that she was out of glue because she would rub glue on her hands and let it dry to make glue handprints — she loved glue handprints.

Young artists always make for exciting company.

For years, my sister and I walked each other home. Eventually, we found others — friends our age, with whom we would now walk. While glue stopped being the topic of discussion, at least for me and my new friend, Paul, there was different glue in the mix — glue that was forming human bonds.

The experiences of adolescence — of fitting in or more often, not fitting in — are frequently painful, particularly when they occur on the verge of young adulthood.

They become less so when they find common ground with others who suffer. The truths Paul and I shared as we walked home together forged strong, perhaps impenetrable, bonds. We were in the process of becoming ourselves, growing into the reality of who we were destined to be.

Time passed, and life journeys separated us. Paul became an advertiser and me, a nurse. Yet that bond from that tenacious glue was still there — holding us together. Even after long stretches of time apart, we resumed a comfortable gait and recalled how easy it was to walk each other home.

And then one day, I spotted a change, a new companion in our group — the virus. We cried and talked about new things, about T-cells, pneumonia, other infections, and the skin cancer that would ultimately betray Paul and tell an unjust yet stereotypical story about him to the outside world. And we continued to walk each other home.

For months I watched. The virus changed Paul. It pulled him away into a new group of those who were different. The most marginalized of the marginalized — all of them with a common companion, but all of them seeming to walk alone.

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“We’re all just walking each other home.” — Ram Dass As life would have it, the day came when I found myself walking alone. I thought Paul might have been lost, perhaps even hidden. Then, slowly, the cold wash of final separation settled over me.

Lost? Hidden? No … home.

It’s been more than 40 years since my parent’s instructions to me, and I find their words still echo in my mind, “she’ll be lost, and she needs you to find the way home.” What I treasure now, more than ever, is that when I know someone’s story, I become a guardian of that story and a companion for the remainder of the journey.

What I’ve learned is that we routinely use labels as a method to artificially separate ourselves. When we use labels that identify others as different, those labels generate an automatic stereotype, notwithstanding intent. What is amazing is that we, as nurses, have volumes of stories that illuminate the continued on page 23

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TNA MEMBER NEWS SPOTLIGHT ON YOU

DISTRICT HONORS In November, TNA District 9 held its 26th annual Nursing Celebration recognizing 20 Outstanding Nurses for 2016. TNA member recipients were: Sandy Branson, UTHealth School of Nursing Becky Chalupa, Houston Methodist San Jacinto Hospital Jaime Choate, Texas Children’s Hospital Tonye Cox-Miller, Bell Tech Career Institute Robert Flores, Memorial Hermann Southwest Hospital Stacy Hall, The University of Texas MD Anderson Cancer Center Deborah Ann Hodge, Memorial Clinical Associates Olinda Johnson, Texas Woman’s University Rosalyn Jones-Waters, Ben Taub Hospital – Harris Health System Cheyenne Darlene Martin, UT Medical Branch School of Nursing & Graduate School of Biomedical Sciences Audrey Pyle, The Menninger Clinic Starla Reichek, Houston Federation of Teachers/Texas American Federation of Teachers Matthew Schlueter, Ben Taub and Quentin Mease Hospitals – Harris Health System President’s Award Recipients: Dorothy Otto Donna Wooten TNA District 2 honored its Panhandle Great 25 Nurses during its annual celebration in October. TNA member recipients:

Betty Henry Dr. Valerie Kiper Laura Reyher Kim Riddlespurger Nora Wells

HONORS & AWARDS TNA District 9 member Marylyn Harris, RN, founder and executive director of the Women Veterans Business Center, was honored in December by the Obama Administration and named a White House Champion of Change. The award highlights Americans making a positive impact in their communities. Harris, a former Army Nurse and Gulf War veteran, aims to educate and empower women veterans through business training opportunities.

She was invited to Washington, D.C. for a private White House tour and reception for honorees.

Nursing Management recognized District 21 member Bob Dent, DNP, MBA, RN, NEABC, CENP, FACHE, as the Richard Hader Visionary Leader 2016.

The distinction is awarded to a nurse leader who views nursing as both an art and a science by promoting caring and competence as the link between science and humanity. Dent is senior vice president, chief operating officer, and CNO for Midland Memorial Hospital in Midland.

APPOINTMENTS & ELECTIONS A forensic nurse at Baylor, Scott & White Hospital in College Station

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Nancy Downing, PhD, RN was recently appointed to the Texas Forensics Science Commission by Texas Governor Greg Abbott. Created in 2005, the commission provides oversight of Texas crime laboratories and other entities conducting forensic analyses for use in criminal proceedings. Downing is also an associate professor at Texas A&M College of Nursing and chair of the International Association of Forensic Nurses Campus Sexual Assault Task Force.

Jonathan Wolfarth, MS, RN-BC, program director for the Texas Peer Assistance Program for Nurses (TPAPN), has been appointed to the newly convened Substance Use Disorder (SUD) Work Group of the American Nurses Association. The purpose of the group is to develop or update ANA policy or to endorse or sign on to an existing position statement on substance use disorder in nursing, as well as identify and/or develop resources to assist nurses and employers before, during, and after SUD recovery. Wolfarth joined TPAPN in July 2016 from the Menninger Clinic in Houston. He is ANCC Board Certified in Psychiatric and Mental Health Nursing as well as Informatics Nursing.

OPPORTUNITY TO SERVE Exclusive opportunity for TNA members!

In April, the TNA Board will appoint new members to the TNA Policy Council and related committees: APRN, Workplace Advocacy, Regulation, and Nursing Education. To apply for committee appointment, visit texasnurses.org. To enable as many as possible to participate in the work of these groups, those not selected for appointment will be included on the expert advisory panel for that particular committee. i

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HEALTHY COMMUNITIES START WITH NURSES

By Cindy Zolnierek, PhD, RN, Executive Director, Texas Nurses Association

To the three-legged stool of health care — quality, costs, outcomes — a fourth leg has been added.

Care of the provider acknowledges that without healthy providers, optimal delivery of care cannot occur. Care of the provider begins with self-care.

THE AMERICAN PUBLIC HEALTH Association defines public health as the promotion and protection of the health of people and the communities where they live, learn, work, and play. Injury and disease prevention, wellness promotion, and healthy community development are all within the sphere of public health. And while public health can be thought of as macro perspectives, e.g. population health, actual public health interventions most often occur on a micro level in local communities — tobacco-free environments, lighted sidewalks that allow people to walk in their communities, and availability of local fresh produce and fluoridated water.

Many have recognized that a focus on community/public health holds promise for bending the curve on chronic disease and quality of life. In 2015, the Robert Wood Johnson Foundation redirected its efforts toward building A Culture of Health. The American Public Health Association initiated a project Healthy Community 50. The Centers for Disease Control implemented a Healthy Communities Program. And, the Centers for Medicaid and Medicare Services launched an Accountable Health Communities model.

Additionally, near the end of 2016 the surgeon general released the first report

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to frame addiction as a public health issue and suggest that the solution lies within a public health framework.

Suicide, at a 30-year high, has been declared an epidemic, a major public health issue. Preventable chronic diseases (e.g. obesity, diabetes, heart disease) impact quality of life as well as longevity and medical costs for an increasing number of Americans; these diseases are public health issues.

Bending the curve on chronic disease and building healthy communities requires nursing involvement at the macro and micro levels. Nurses are called to be active in their professional associations,

which advocate for public health policy, as well as within their local communities to advocate for safe, healthy environments. But perhaps most importantly, we nurses are called to participate as individuals — to examine our own behaviors, habits, and choices and consider how we can improve our own health status and thus become a role model for others.

To the three-legged stool of health care — quality, costs, outcomes — a fourth leg has been added. Care of the

provider acknowledges that without healthy providers, optimal delivery of care cannot occur. Care of the provider begins with self-care.

Healthy Nurse, Healthy Nation is an initiative of the American Nurses Association focused on promoting the health and well-being of nurses. When we are at our best, we can perform at the top of our practice to benefit our patients. TNA is participating as a Premier Partner of this initiative, and we encourage Texas

nurses, whether TNA members or not, to participate with us in making our individual contributions to the health of our state and nation. For more information, visit the TNA website at texasnurses.org.

ANA is also designating 2017 the Year of the Healthy Nurse, which will focus on five domains of health: physical activity, nutrition, safety, quality of life, and sleep/ rest. (See article on fatigue on page 10). continued on page 23

THE HEALTHY NURSE, HEALTHY NATION™ GRAND CHALLENGE \’Grand ‘Chal-enge\: bold, socially beneficial goals that successfully address a systemic and embedded problem through collaboration and joint leadership.

The Healthy Nurse, Healthy Nation™ (HNHN) Grand Challenge is a national movement designed to transform the health of the nation by improving the health of the nation’s 3.6 million registered nurses.

HNHN WILL: >

Broadly connect and engage individual nurses, employers of nurses, state nurse organizations, and specialty nurse associations to take action within five domains: physical activity, rest, nutrition, quality of life, and safety.

>

Provide a web platform to inspire action, cultivate friendly competition, provide content and resources to users, gather data, and serve to connect registered nurses with each other, with employers, and with organizations.

In a number of significant indicators, nurses are less healthy than the average American. Nurses are likely to be overweight, have higher levels of stress, and get less than the recommended hours of sleep. Because health care delivery

requires 24/7 support, the demands of shift work challenges the health of nurses.

SAFETY In addition, hazards such as workplace violence and musculoskeletal injuries are contributing factors to poorer health. According to the Bureau of Labor Statistics, when compared with all other occupations, registered nurses have the fourth highest rate of injuries and illnesses that result in days away from work.

As the largest group of health care workers, nurses are critical to America’s healthcare system. Nurses protect, promote, and optimize the health of their patients by preventing illness and injury, facilitating healing, and alleviating suffering. Their well-being is fundamental to the health of our nation. Nurses should be viewed as exemplars of health and serve as role models for their patients, colleagues, families, and communities. \’Grand ‘Chal-enge\: bold, socially beneficial goals that successfully address a sys-

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NUTRITION

REST

PHYSICAL ACTIVITY

QUALITY OF LIFE

temic and embedded problem through collaboration and joint leadership.

The domains of Health Nurse, Healthy Nation™ will include the areas of: Physical Activity Rest Nutrition Quality of Life Safety continued on page 23

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TEX AS NURS ES AS SOCIATION

FATIGUE: injuries, musculoskeletal disorders, mood disorders, and many other health concerns (Bae & Fabry, 2014; Bannai & Tamakoshi, 2014; Kleppa, Sanne & Teil, 2008; Knutsson & Boggild, 2010).

Fatigued nurses may also put their patients’ safety in jeopardy. Studies indicate that extended shifts worked by hospital staff nurses are associated with higher risk of errors and reduced ability to recognize errors. Working fatigued has been shown to have a negative effect on the nurse’s ability to deliver optimal patient care leading to an increased risk of patient care errors and other performance deficits while on duty and while driving a motor vehicle (Geiger-Brown et al., 2012; Landrigan et al., 2004; Lockley et al., 2007; Scott, Arslanian-Engoren & Engoren, 2014; Scott, Rogers, Hwang & Zhang, 2006; Scott, Hofmeister, Rogness & Rogers, 2010; Trinkoff et al., 2011).

KAREN IS A REGISTERED NURSE in the critical care unit of Central Community Hospital where she works 12-hour shifts from 7:00 a.m. to 7:00 p.m. three days a week. Since her husband has been out of work, she is also picking up extra shifts at the county hospital. She often works five 12-hour shifts per week between the two sites. Since taking on the extra shifts, Karen feels exhausted with little time for proper rest, exercise, or making healthy meals.

She is concerned about the quality of her nursing practice because she is sometimes not able to concentrate on the important details of her patients’ conditions since she is so fatigued. Unfortunately, she

does not see how her family can survive financially without the income from her extra shifts.

A COMMON CHALLENGE Karen’s situation is not unusual. Nurses have many opportunities for working beyond the typical 40 hour work week, which can be financially rewarding yet physically and mentally draining, and possibly even harmful to long-term health. In fact, research on workers in various occupations provides evidence that fatigue and long working hours has a negative impact on a worker’s health and safety including sleep disturbances,

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How much is too much when it comes to working hours for the nurse? The Institute of Medicine recommends that RNs not exceed 12 hours of work in a 24-hour period and 60 total hours of work within seven days (Institute of Medicine of the National Academies, 2004). The American Nurses Association (ANA) recommends that RNs not exceed 40 hours of professional nursing work (paid or unpaid) in a seven-day period.

PROFESSIONAL RESPONSIBILITY Perhaps more important than specific recommendations on work hours is the nurse’s own professional responsibility to come to work rested, alert, and prepared to give full energy and attention to his/ her nursing practice and to support team members and colleagues to provide a safe and effective patient care environment. Provisions in the Nurses Code of Ethics (ANA, 2016) clearly establish the nurse’s responsibility for promoting, advocating, and protecting the health and

A NURSE’S RESPONSIBILITY TO SELF & PATIENTS

By Barbara Cherry, DNSc, MBA, RN, NEA-BC; Kathryn Pecenka-Johnson, MS, BSN; and Ellen Martin, PhD, RN, CPHQ

safety of the patient as well as promoting and protecting the nurse’s own individual health and safety.

While it is clear that nurses must honor their professional responsibility to balance their personal and professional lives in preparation for the significant responsibilities that come with nursing practice, what responsibility do employers have for addressing nurse fatigue? In its position statement entitled Addressing Nurse Fatigue to Promote Safety and Health: Joint Responsibilities of Registered Nurses and Employers to Reduce Risks, ANA states that nurses and employers have a joint responsibility to “reduce risks from nurse fatigue and to create and sustain a culture of safety, a healthy work environment, and a worklife balance” (ANA, 2014, p. 1). Specifically, ANA recommends that employers adopt an official policy that allows RNs to refuse a work assignment because of fatigue. Further strategies for addressing and preventing the risks of working fatigued for both the employer and nurse are noted in the table (right).

Karen resolves to pay more attention to self-care, knowing that when she is healthy and rested, she not only can provide the safest possible care for her patients, but also be an attentive mother and wife. Every nurse needs to make the same personal commitment — to take care of themselves first, so that they can provide the best care to others. i REFERENCES American Nurses Association (2016). Code of ethics for nurses. Available online at nursingworld.org/ codeofethics.

American Nurses Association. (2014). Addressing Nurse Fatigue to Promote Safety and Health: Joint Responsibilities of Registered Nurses and Employers to Reduce Risks. Available online at nursingworld.org/ MainMenuCategories/WorkplaceSafety/HealthyNurse/bullyingworkplaceviolence/Addressing-NurseFatigue-to-Promote-Safety-and-Health.html Bae, S., & Fabry, D. (2014). Assessing the relationships

STRATEGIES TO ADDRESS AND PREVENT FATIGUE (adapted from ANA’s 2014 Position Statement: Addressing Nurse Fatigue to Promote Safety and Health: Joint Responsibilities of Registered Nurses and Employers to Reduce Risks.)

NURSE’S RESPONSIBILITIES

EMPLOYER’S RESPONSIBILITIES

Sleep seven to nine hours per 24 hours.

Reduce reliance on overtime as a staffing solution.

Improve overall personal health and wellness through stress management, nutrition, and exercise.

Adopt as official policy that RNs can reject a work assignment in good faith on the basis of fatigue with no adverse consequences.

Take scheduled meals and breaks during the work shift.

Establish at least 10 consecutive hours per day of protected time off for nurses to obtain seven to nine hours of sleep.

Avoid driving drowsy — consider public transportation, a taxi, or calling a friend or family member to drive you home if necessary.

Institute anonymous reporting systems for errors and near misses and include risk for fatigue-related errors in incident investigations.

Be willing to negotiate or reject a work assignment if you are too fatigued.

Promote fatigue management education for employees and managers, including education about sleep disorders.

Be willing to initiate discussion with a colleague if they seem impaired from fatigue.

Use evidence based recommendations to design work schedules (See ANA’s Principles of Nurse Staffing).

Be aware of your personal and ethical responsibility to go to work rested, alert, and able to take on the immense responsibility of safe nursing practice.

Reduce risks of drowsy driving by providing transportation home when a nurse is too tired to drive safely.

between nurse work hours/overtime and nurse and patient outcomes: Systematic literature review.

Nursing Outlook, 62(1), 138–156.

Bannai, A., & Tamakoshi, A. (2014). The association between long working hours and health: A systematic review of epidemiological evidence. Scandinavian Journal of Work, Environment & Health, 40(1), 5–18.

Geiger-Brown, J., Rogers, V. E., Trinkoff, A. M., Kane, R. L., Bausell, R. B., & Scharf, S. M. (2012). Sleep, sleepiness, fatigue, and performance of 12-hour-shift nurses. Chronobiology International, 29(2), 211–219.

Kleppa, E., Sanne, B., & Tell, G. S. (2008). Working overtime is associated with anxiety and depression: The Hordaland health study. Occupational and Environmental Medicine, 50(6), 658–666.

Knutsson, A., & Boggild, H. (2010). Gastrointestinal disorders among shift workers. Scandinavian Journal of Work, Environment & Health, 36(2), 85–95.

Landrigan, C. P., Rothschild, J. M., Cronin, J. W., Kaushal, R., Burdick, E., Katz, J. T., & Czeisler, C. A. (2004). Effect of reducing interns’ work hours on serious medical errors in intensive care units. New England Journal of Medicine, 351(18) 1838–1848.

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Lockley, S. W., Barger, L. K., Ayas, N. T., Rothschild, J. M., Czeisler, C. A., & Landrigan, C. P. (2007).

Effects of health care provider work hours and sleep deprivation on safety and performance. Joint Commission Journal on Quality & Patient Safety, 33(11 Suppl):7-18.

Scott, L. D., Arslanian-Engoren, C. M., & Engoren, M. (2014). The association of sleep and fatigue with decision regret among critical care nurses. American Journal of Critical Care, 23(1), 13–23.

Scott, L. D., Rogers, A. E., Hwang, W. T., & Zhang, Y. (2006). Effects of critical care nurses’ work hours on vigilance and patients’ safety. American Journal of Critical Care, 15(1), 30–37.

Scott, L.D., Hofmeister, N., Rogness, N., & Rogers, A.E. (2010). An interventional approach for patient and nurse safety: a fatigue countermeasures feasibility study. Nursing Research 2010 Jul-Aug;59(4):250-8.

Trinkoff, A. M., Johantgen, M., Storr, C. L., Gurses, A. P., Liang, Y., & Han, K. (2011). Nurses’ work schedule characteristics, nurse staffing, and patient mortality.

Nursing Research, 60(1), 1–8.

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DELIVERING YOUR MESSAGE POWERFULLY

By Lisa Campbell, DNP, RN, APHN-BC

NURSES PLAY A KEY ROLE in policy advocacy and, to that end, have a moral obligation to be involved in sociopolitical activities (Falk-Rafael, 2005). Policy advocacy requires a well-researched message delivered succinctly to policy makers with the intent to inform. The ultimate aim is to improve health by influencing decisions (Spenceley, Reutter, & Allen, 2006).

The Texas Legislature meets for 140 days every two years. During the last session, more than 6,200 bills were filed. Legislators and staffers cannot be familiar with every bill; they rely on constituents to educate them on the specifics. Some lawmakers, due to party affiliation, personal beliefs, etc. are predisposed to support — or oppose — your position, which means that communicating with those who are undecided is where you can make the biggest impact.

Successfully communicating with a lawmaker or staff member involves a few very important aspects: Appearance

Message

Knowledge

APPEARANCE AFFECTS IMPACT — FOR BETTER OR FOR WORSE Coco Chanel put it brilliantly, “Dress shabbily and they remember the dress; dress impeccably and they remember the woman.” Of course you can substitute any pronoun you wish for ‘woman,’ but the point is a cogent one — you want a policy maker or person of influence to remember your message.

Some may think their message is so powerful no one will notice how they look.

However, they should reconsider a few facts. Neuroscientists at Massachusetts Institute of Technology discovered that the brain can process images it sees in as little as 13 milliseconds (Trafton, 2014, January 16). In other words, people can interpret what they see and make judgments and corresponding decisions about another in the blink of an eye. Given this almost superpower-like ability, it is in the best interest of policy advocates and nurses to represent themselves well to minimize distractions from what is ultimately most important — the potency and persuasiveness of your message.

MINIMIZE DISTRACTIONS According to Merriam-Webster (2017), a distraction is something that makes it difficult to think or pay attention. Let us consider, for example, a busy Texas state representative who has many policies to consider during the 85th Legislative Session. We can assume she has lots of distractions and many individuals vying for her time. You schedule a visit with this representative in Austin about TNA’s position that supports full practice authority for APRNs and arrive on time to meet with your representative.

You are dressed in your favorite pair of

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blue jeans containing a few indelible salsa stains from your favorite Tex-Mex restaurant — the jeans are kind of dark, so maybe no one will notice. Also, you are feeling a bit nostalgic, so you throw on your trusty, 10-year-old wind breaker you’ve nicknamed “windy.” Windy has a few holes, but she still does her job well enough! Finally, you are feeling a bit folksy too, so you put on your trusty, scuffed-up cowboy boots you won at the college rodeo — surely it will show your true grit.

After you walk in the representative’s office, you deliver your message as well as you can in the 15 minutes you have.

However, you notice that, although nice, the representative seems very distracted by what you are wearing and seldom looks you in the eyes, focusing on what you are saying only 10 minutes into the conversation when she starts asking a few questions too general to indicate you held her full attention. This was a lost opportunity to influence a policymaker. However, the short falls noted in this example may be avoided by being cognizant of a few simple principles.

Influence takes on many forms, such as your position and who you know; it requires effective communication both

verbal and non-verbal. Appearance includes choice of clothing, color, hairstyle, and sometimes a personal signature (a man’s bowtie or woman’s brooch).

Confidently delivering your prepared message enhances your impact. A succinct delivery by a confident, professional-looking constituent increases the chance of success of your visit.

MESSAGE IS MORE THAN JUST WHAT YOU SAY

COMMUNICATING KNOWLEDGE

Prior to your visit, identify one or two bills that you would like to discuss. You don’t need long words; instead you need something you can easily say and easily remember — both you and them.

The lawmaker or staff member will likely ask you additional questions. You should be prepared to answer any obvious questions. However, if you do not know the answer, DON’T FAKE IT!! Simply say you don’t know the answer and that you will find out. Make sure you follow up with the person who asked.

Check with the Texas Nurses Association about core messages. The TNA website and TNA Government Affairs staff have information about nursing’s position on general issues as well as specific bills.

One of the most effective ways to answer questions about legislation is to tie the answer to your practice. Share a story about a patient (without breaking patient confidentiality) or coworker and how they need this legislation or how this legislation will hurt them. Stories about real people not only make it easier to understand the technicalities of legislation, but also humanize the legislation to show the human experience.

Your core message should encompass:

The bill number and short description.

Whether you support or oppose it.

Why you support or oppose it.

(Focus on one or two major points.)

Choose major points that you think would resonate with the law maker.

CALL TO ACTION

ALL ASPECTS OF COMMUNICATIONS

Generally this means to request their support or opposition; sometimes it means to support/oppose at the committee level if the lawmaker is in such a position.

If you aspire to influence decision makers, politicians, colleagues, friends, and family, then taking time to reflect on the image you want to portray is a valu-

able endeavor. The bottom line is that appearance is an important part of the messages we communicate every day and is crucial to effectively delivering our message. However, regardless of one’s view on professional dress, nurses must diligently engage in policy advocacy to ensure the health of all citizens.i REFERENCES Falk-Rafael, A. (2005). Speaking truth to power: Nursing’s legacy and moral imperative. Advances in Nursing Science, 28(3), 212-223.

Pagana, K. D. (2015). The nurse’s etiquette advantage (2nd ed.). Indianapolis, IN: Sigma Theta Tau International Spenceley, S. M., Reutter, L., & Allen, M. N. (2006).

The Road Less Traveled: Nursing Advocacy at the Policy Level Policy, Politics and Nursing Practice,, 7(3), 180-194.

Trafton, A. (2014, January 16). In the blink of an eye.

Retrieved from news.mit.edu/2014/in-the-blink-of-aneye-0116

ABOUT THE AUTHOR: Lisa Campbell, DNP, RN, APHN-BC, is an associate professor at Texas Tech University Health Sciences Center School of Nursing and teaches in the Doctor of Nursing Practice Program. Dr. Campbell engages students in real-world population health and policy projects. She was recently elected as chair-elect for the American Public Health Association’s Public Health Nursing Section.

A PROFESSIONAL IMAGE Have you been wearing the same clothes and make-up for years? Do people tell you that you haven’t changed a bit? It is easy to get in a rut and not take time to update your “look.”

You can start with buying a few magazines to review current styles. However, professional attire has not changed significantly in decades. Preference is an important consideration; slacks and a nice jacket, a suit, or other culturally appropriate professional attire. Lastly, you don’t have to spend a lot of money on professional clothes. There are numerous inexpensive options such as resale shops and end-of-season clothing sales.

When was the last time you changed your hairstyle?

I have been asked if it is necessary to color gray hair. Today it is more important to have a good haircut than to color your hair. Consider the shape of your face and age when making a decision about your hairstyle. As an example, I have personally found that a shorter haircut gives me a youthful appearance.

Do your clothes fit properly?

Properly fitting clothes can be a sticky issue. Thankfully, we all come in different shapes and sizes. To that end, clothes look best when they skim or drape the body and are the right length. As an example, I am a shapely, mature woman and look best when my suit does not look like shrink-wrap cellophane.

Actually, that would be really scary and surely distract from my message.

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2017

TEX AS NURS ES AS SOCIATION

TNA BALLOT ANNOUNCED

THE TEXAS NURSES ASSOCIATION’S Nominating Committee announced on Dec. 15, 2016, the following proposed ballot.

Candidate positions for ballot placement were selected by random drawing.

SECRETARY 2017-2019 Debbie Peña, MSN, RN, Victoria “Being a member of Texas Nurses Association has had such an important and positive impact on my life. It has encouraged me to be a ‘Voice’ for Texas Nurses! When nurses speak, legislators listen! As Secretary, I would like to help welcome new members and retain existing members. I would also like to be a part of the nursing shortage solution.”

A Registered Nurse since 1996, Debbie Peña, MSN, RN, has been active with TNA since 2009. She has served as president of District 20, participated in Nurse Day at the Capitol, and from 2011 to 2016 she represented District 20 at the TNA House of Delegates. In addition, she organized the District 20 Golf Tournament Fundraiser for Nursing Scholarships from 2010-2014.

Kleanthe Caruso, MSN, RN, NEA-BC, Tyler “I want to contribute to building a leadership infrastructure to keep TNA strong and drive change at the local and state levels. My previous administrative positions and contacts with state and national leaders have given me valuable knowledge and sensitivity to the voices of nurses and health care providers and consumers. I will use that knowledge to advocate for the profession and give voice to the concerns and realities of the times.”

Currently a clinical instructor with the University of Texas at Tyler, Kleanthe Caruso, MSN, RN, NEA-BC, is a former president of District 19 and a former TNA board member. She served as chair of the Board of the National Commission on Correctional Health Care and currently is a member of TNA’s inaugural Policy Council.

TREASURER 2017-2019 (Choose One) Patricia Morrell, DNP, RN, NEA-BC, Winnie “I have a long history with Texas Nurses Association at the local and state level … I believe that TNA is the voice for Texas nurses and as such, it will be my responsibility and duty to serve as an advocate for nursing in Texas. I have been involved in the TNA transition process over the last several years and … can proudly represent the nurses of Texas as I have done in the past.”

Patricia Morrell, DNP, RN, NEA-BC, is the Director of Professional Practice for CHRISTUS Southeast Texas Health System.

A former President of District 12, Morrell has been active in the TNA Government Affairs Committee, chairing it for four years. She has also served on the TNA Board for the past two years.

Gayle H. Dasher, PhD, RN, ANP-BC, San Antonio “As our profession evolves … TNA needs to continue to respond to the question, ‘What matters most to nurses, and how do we attain those goals?’ The financial health of TNA and the wise stewardship of our resources will in no small way impact the manner in which we work to achieve those goals. Our available resources will impact our ability to develop, refine, and

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implement the initiatives that are vital to moving nursing forward in the state.”

A Registered Nurse since 1983, Gayle Dasher, PhD, RN, ANP-BC, is the Director of Clinical Practice at CHRISTUS Santa Rosa Health System in San Antonio. She is a member of TNA’s inaugural Policy Council, a former president of District 8, and a former member of TNA’s Finance Committee.

DIRECTOR-AT-LARGE

POSITION #1, Representing a Smaller District 2017-2020 (Choose One)*

Karen KoerberTimmons, PhD, RN, CNE, NEA-BC, CCRN, RN-BC, Ore City “I currently am in a unique position to work with various stakeholders in an inter-professional and interdisciplinary approach as a nurse leader, nurse educator, critical care nurse, and active community service influence to advance critical TNA priorities for the future of health care in the state of Texas.”

A professor at the University of Texas at Tyler School of Nursing, Karen KoerberTimmons, PhD, RN, CNE, NEA-BC, CCRN, RN-BC, is president of TNA District 19, a member of the TNA Government Affairs Committee, and on the TNA/TONE Health IT Toolkit Committee. She has represented District 19 several times at the TNA House of Delegates and has also served as the Faculty Liaison to the Texas Nursing Students Association for almost 10 years.

Andrea Kerley, MBA, MSN, RN, Abilene “The foundation of strength for TNA not only lies with the TNA staff in Austin, but our membership. My years as a TNA member and district president of a small district have given me a good

perspective on the challenges small districts face. Reaching the nurses in these districts … is vital to meet their needs for resources that are often lacking, as well as to provide their voice in the legislative agenda.”

Currently a clinical analyst with Hendrick Medical Center, Andrea Kerley, MBA, MSN, RN, has been with Hendrick since 1995. She has served as the president of District 15 since 2007 and was a member of the TNA Nominating Committee. She has also been a Texas Peer Assistance Program for Nurses (TPAPN) nurse advocate since 2001.

Patricia Freier, MSN, RN-BC, RCIS, Lubbock “Advocating for nurses to be able to embrace practicing to the fullest extent of their education and training includes health policy engagement. Texas Nurses Association has a rich history of policy development and legislative navigation. It is a great privilege to serve my profession … I will work to engage more nurses from a diverse workforce to protect and serve the citizens of Texas.”

MSN • Family Nurse Practitioner • Nurse Administrator • Nurse Educator RN to BSN

Former president of District 18, Patricia Freier, MSN, RN-BC, RCIS, has also served on the district Nominating Committee and as chair of the District 18 GAC. Since 2008, she has been a member of the TNA CNE Committee and has been active in the TNA Government Affairs Committee. She is currently a project specialist for quality improvement at Covenant Health, where she has worked since 1991. *TNA Bylaws, Article VIII Board of Directors and Duties of the Board, Section 1. Composition of the Board: The Board of Directors shall be the four officers plus five directors-at-large. At least one of the directors-at-large shall not be a member of the five largest districts. For purposes of this section, a district-at-large shall not be counted as one of the five largest districts regardless of the number of members.

DIRECTOR-AT-LARGE POSITION #2, 2017-2020 (Choose One)** **Do not vote for the same person twice. After voting for a candidate for Position #1, do not vote a second time for that candidate for Position #2.

Karen Koerber-Timmons, PhD, RN, CNE, NEA-BC, CCRN, RN-BC, Ore City (See bio above.)

Andrea Kerley, MBA MSN RN, Abilene (See bio above.)

Shakyryn Napier, DHSc, MSN, RN, CPN, Aledo “I strongly believe in TNA and its commitment to nurses in Texas … I would like to focus on promoting a better understanding of TNA and its benefits to both current and future members … [and] on active engagement of current bedside nurses with a particular focus on newly graduated nurses to continue to build a strong future for TNA and the nursing profession.”

Shakyryn Napier, DHSc, MSN, RN, CPN, is a nursing director at Cook Children’s Medical Center. A former president of District 3, she is active in the TNA Government Affairs Committee and serves as the District 3 GARD (Government Affairs Representative for District). Napier was a member of the TNA Finance Committee and in 2016, received the District 3 President’s Award. continued on page 17

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W I N T E R 2 017 | T E X A S N U R S I N G M AGA Z I N E

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2017 TNA BALLOT ANNOUNCED continued from page 15

Clarissa Silva, PhD, MSN, RN, San Antonio “The Texas Nurses Association gives nurses a strong voice… I would make sure that all communication that is needed to be delivered to the Texas Nursing public was disseminated in an efficient and concise manner… I think that use of all our technology should be utilized to reach our members in the Texas Community Districts.”

A Registered Nurse since 1991, Clarissa Silva, PhD, MSN, RN, is currently the director of simulation and clinical learning lab for the Galen College of Nursing in San Antonio. She has been a member of TNA since 2013 and has served as secretary and first vice president for TNA District 8. She also represented District 8 at the 2014 House of Delegates.

Patricia Freier, MSN, RN-BC, RCIS, Lubbock (See bio above)

NOMINATING COMMITTEE 2017-2019 (Elect Two) Irene Rosales, MSN, RN, Laredo “It is my desire to work diligently to make the nominating process as smooth as possible.

I possess prior experience as a member of the nominating committee for TNA District 8 and TSNO [Texas School Nurse Organization]. If elected, I will ensure that everyone that would like to run for a selected office is given the opportunity and the guidance to fulfill their information promptly. I will ensure that the process is expedited and thorough to ensure we have enough candidates to fill the elected positions.”

A Registered Nurse since 1989, Irene Rosales, MSN, RN, is the Health Services Director for United Independent School

District. She has represented District 8 at the TNA House of Delegates. In 2016, she was inducted into the Laredo Commission for Women Hall of Fame.

Susan RamnarineSingh, EdD, MSN, RN, Harker Heights “I have been an active member since 2008 at my district level. With my present and past experience, [I] want to serve at the state level to help expand the mission and vision of TNA.” Susan Ramnarine-Singh, EdD, MSN, RN, is seeking re-election to the TNA Nominating Committee. She is currently the simulation coordinator and a professor of nursing at Central Texas College. Prior to joining CTC, she served two decades in the Army Nurse Corps, retiring in 2005.

Ramnarine-Singh has been on the District 7 Board of Directors for nine years in various capacities, including secretary.

She also handles social media and the website for District 7. Ramnarine-Singh was recently awarded the DAISY Faculty Award by the CTC Nursing Department.

Orlando Chapa, DNP, RN, NE-BC, Aledo “This committee plays a vital role in vetting and slating an outstanding ballot for TNA members. During my first term, I gained valuable firsthand knowledge of the work and challenges in developing a statewide ballot. I am confident this initial exposure allows me to hit the ground running during a second term. As a committee, we have an opportunity to network and identify our candidate pool early. We have and need our strong nursing leaders throughout the state to guide our TNA mission.”

Assistant Vice President of Nursing at Cook Children’s Medical Center, Orlando Chapa, DNP, RN, NE-BC, is seeking re-election to the Nominations Committee. He is active in District 3 and has represented the district at the TNA House of Delegates.

PAGE 17

Laura Opton, DHSc, RN, CNE, Lubbock “This is an exciting time for nursing, and the next generation of leaders must be compassionate, knowledgeable, and assertive professionals who are prepared to advocate for nurses in all settings and to promote the common purpose identified by TNA of advancing nursing excellence.

If elected to serve in the Nominating Committee, I will collaborate with the other members to recognize outstanding individuals that will make these initiatives a reality.”

Laura Opton, DHSc, RN, CNE, is the director of the Accelerated BSN Program (second degree BSN track) and an associate professor at Texas Tech University Health Sciences Center School of Nursing. She has chaired the District 18 Nominating Committee and participated in the planning of the District 18 Nurse Week Banquet. i

2017

TNA BALLOT

HOW TO VOTE The 2017 TNA Election will occur on Saturday, April 29 at the 2017 TNA House of Delegates.

Delegates will have the opportunity on Friday, April 28 to hear the candidates present their platforms and discuss how they can further TNA’s mission while working to implement the association’s strategic goals. Delegates will also have a “Meet & Greet” reception with candidates so that they may make an informed decision before casting their ballots during the voting session of the House of Delegates the next morning.

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SUPPORT YOUR DISTRICT AT 2017 HOUSE OF DELEGATES Join Us April 28 – 29 TNA 2017 HOUSE OF DELEGATES DATE: April 28 – 29, 2017 TIME: 3:00 p.m. Friday through 4:00 p.m. Saturday

DISTRICTS ARE EXPECTED TO FILL THEIR DELEGATE SEATS! TNA Active District Status Policy

LOCATION: Sheraton Hotel Georgetown

IV. D. Proxies to the House of Delegates are kept to a minimum.

IN 2014, THE TNA HOUSE OF DELEGATES directed the Board and staff to develop a new model for TNA. The following year, the TNA Plan for Renewal was enthusiastically supported by TNA delegates.

That plan included changes in services to members and districts, new options for district structure, and perhaps most important, changes in TNA governance to enhance membership engagement and leadership development.

district members at the House is an indication that the district may

For the first time, this year delegates will elect TNA’s secretary, treasurer, and two at-large directors. Additionally, delegates will provide direction to the association by considering bylaws changes and resolutions and engaging in conversations that matter. Delegates will make significant decisions to guide TNA’s future — WE NEED YOU THERE!

To make decisions to direct the future of TNA

To advise the Board and staff of issues of importance to you

To elect new leaders for TNA i

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not be successfully engaging members. Use of proxy votes for

<

more than two years in a row will result in review by the TNA Board.

WHAT YOU CAN EXPECT FRIDAY:

Issues Forum: Discussion and Q&A re: proposed bylaws changes, resolutions, and other business of the association Candidate Forum: Secretary, Treasurer, two directors, and two Nominating Committee members

Get to Know the Candidates Reception

SATURDAY:

TNA Business Meeting Guest Speaker: Marla Weston, PhD, RN; CEO, ANA Enterprise PAC Fundraising Event Conversations That Matter (for delegates and observers!)

<

In surveys, members consistently report that attendance at the TNA House of Delegates was a peak experience.

TNA’s Plan for Renewal capitalized on this opportunity to engage members and elevated its importance — shifting important governance functions to the House.

While proxies are allowed in the bylaws, the inability to represent

YOUR INTEREST PIQUED? Contact your district leadership (www.texasnurses.org/?page=TNADistricts) and let them know that you would like to participate as a delegate.

Attended before? Recommend the delegate role to another member!

District leadership? Put out a call for delegates. Be sure to select alternates in case a delegate is unable to attend at the last minute.

Know someone new to the organization? Invite them to participate as an “observer.”

See you there!

PAGE 18

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FINAL RECOMMENDATIONS ADOPTED

BY THE SUNSET COMMISSION

By Cindy D. Zolnierek, PhD, RN, Executive Director, Texas Nurses Association

UNDER THE TEXAS SUNSET PROVISION, governmental agencies are set to expire on a certain date unless the Legislature passes a bill to authorize the agency’s continuation. The Sunset process is intended to provide for a regular and thorough review of agencies to determine whether the agency needs to continue and, if so, how it can function most effectively and efficiently.

In 2016, several health occupational boards underwent Sunset review, including the Board of Nursing. On Dec. 8, the Sunset commission adopted the following recommendations for changes in statute affecting the Texas Board of Nursing:

graduates of out-of-state programs that are determined not to be substantially equivalent to Texas programs.

ISSUE 1: EXCELSIOR’S NURSING PROGRAM EXCEPTION

3.1 Require the board’s peer assistance program to develop and use flexible program requirements in line with nurses’ needs and diagnoses.

Remove the Dec. 31, 2017, expiration date for Excelsior College’s exception to nursing education requirements. Create process, similar to steps for an in-state program, for program improvement or expiration of the exception if Excelsior’s national exam passage rate falls below the board’s standard (80 percent) for consecutive years.

ISSUE 2: STANDARDS LEADING TO SANCTIONS AGAINST NURSES Clarify the definitions of unprofessional conduct and good professional character to limit their application to the practice of nursing.

ISSUE 3: TEXAS PEER ASSISTANCE PROGRAM

3.2 Require the board to create a formal process to allow students an opportunity for re-evaluation of participation in peer assistance upon initial licensure.

3.3 Require the board to create a formal process to allow students an opportunity for re-evaluation of participation in peer assistance upon initial licensure.

Require the board to develop a path to initial licensure for

YOU WERE REPRESENTED! As an interested stakeholder, TNA participated in the Sunset process on many levels.

SUNSET COMMISSION MEMBERS

TNA’s Regulatory Committee provided input into feedback provided to Sunset staff.

SENATORS

REPRESENTATIVES

TNA consulted with other stakeholders, e.g. the APRN Alliance and Texas Hospital Association, regarding feedback.

Van Taylor, Vice-Chair

Larry Gonzales, Chair

Juan Hinojosa

Cindy Burkett

Upon our request, Sunset staff met with TNA to consider our perspectives.

Robert Nichols

Dan Flynn

Charles Schwertner

Richard Peña Raymond

Sunset staff met with TPAPN staff and attended an Advisory Committee meeting to learn about the program.

Kirk Watson

Senfronia Thompson

LTC (Ret) Allen B. West

William Meadows

(Public member)

(Public member)

TNA provided public testimony (written and oral) to the Sunset Commission.

TNA represented the face of nursing during the final consideration of recommendations.

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SO WHAT’S NEXT? SUNSET REVIEW PROCESS Summer 2016 Sunset staff considers -­‐ Board of Nursing self-­‐evalua2on -­‐ Confiden2al input from stakeholers and develops a report with recommenda9ons

Fall 2016 Sunset Commission considers -­‐ Sunset staff report and recommenda2ons -­‐ Agency response to report -­‐ Public tes2mony and may pose modifica9ons to recommenda9ons before vo9ng on final recommenda9ons for Sunset Bill

ISSUE 4: NEW NURSE LICENSURE COMPACT

Spring 2017 The Sunset Bill proceeds through the usual process through the Senate and House: commiAee hearings, debate and modifica2ons, vote in each chamber, and if passed to Governor for signature

of the final recommendations and will be closely monitoring bill progress and evaluating any amendments proposed.

4.1 Adopt the new Nurse Licensure Compact.

To access the Board of Nursing Sunset Report and for more information about the process, visit www.sunset.texas.gov. i

ISSUE 5: IMPROPER PRESCRIBING OF CONTROLLED SUBSTANCES 5.1 Clarify statute and provide direction for the board to monitor advanced practice registered nurses’ improper prescribing of controlled substances.

MARK J. HANNA, JD ATTORNEY AT LAW

ISSUE 6: STANDARD ELEMENTS OF SUNSET REVIEWS 6.1 Update the standard across-the-board requirement related to board member training.

6.2 Discontinue the board’s two reporting requirements and eliminate the specific statutory authority for nurse competency pilot programs.

Experienced Legal Representation for Texas Nurses

And, most importantly…

ISSUE 7: NURSING REGULATION 7.1 Continue the Texas Board of Nursing for 12 years.

In addition, the Commission adopted a provision regarding prescription monitoring that was not part of the original report: Program database and review a patient’s prescription history before prescribing opioids, benzodiazepines, barbiturates, or carisoprodol. An advanced practice registered nurse who does not check the database before prescribing these drugs would be subject to disciplinary action by the Nurse Board.

P: (512) 477-6200 F: (512) 477-1188 mhanna@markjhanna.com

Law Offices of Hanna & Anderton 900 Congress Ave., Suite 250 Austin, Texas 78701

This provision was adopted as a new issue for various prescribers, e.g. veterinarians, podiatrists, etc.

Commission-adopted recommendations will now be drafted into a bill for consideration by the legislature. TNA is supportive

Not certified by the Texas Board of Legal Specialization

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TEX AS NURS ES AS SOCIATION

PREVENT. OBSERVE. WARNING SIGNS. EDUCATE. REPORT.

ABUSE, NEGLECT, AND EXPLOITATION ANE TRAINING ACADEMY FREE TWO-DAY TRAINING EVENT!

is an approved provider of continuing nursing education by the Texas Nurses Association – Approver, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

This training will focus on screening for and preventing ANE, as well as challenging the status quo to reduce desensitization to ANE and change the environments that promote ANE.

Texas Health and Human Services, Medicaid and Social Services Division, is an approved provider of continuing education credit for licensed social workers, HHSC will off CEs/clock hours to social workers, licensed nursing facility administrators, nursing facility activity directors, and certified nurse aides. i

TEXAS TRAINING DATES: SAVE THE DATE! May 17 – 18 San Antonio

June 21 – 22 Edinburg

July 12 – 13 Houston

May 24 – 25 Dallas

June 28 – 29 Dallas

July 19 – 20 Abilene

Protect Your License!!

June 14 – 15 Corpus Christi

If you have received:

WHO SHOULD ATTEND? Primarily front-line staff who provide direct care to nursing facility residents. Other nursing facility staff will also benefit.

Letter of Investigation from the Texas Board of Nursing Notice of Peer Review

HOW TO REGISTER Registration Begins March 2017.

Call today, delay is not an option!

For more information, visit hhs.texas.gov/qmp or email Karen.Lose@hhsc.state.tx.us.

Joyce Stamp Lilly RN JD

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713.759.6430 jslilly@nurse-lawyer.com www.nurse-lawyer.com

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PRESIDENT’S COLUMN continued from page 5 depth and breadth of the human experience. When those stories are told, they have the potential to shatter labels and open the windows to a society filled with greater understanding.

We are all keepers of the stories of joy, pain, love, and hope, and thus keepers of others — this is what we do as nurses.

It is those stories that will transform our

HEALTHY COMMUNITIES START WITH NURSES continued from page 9 For more information nurses can follow ANA on social media and watch for the national launch in May. TNA is a member of the following coalitions concerned with public health:

Texas Public Health Coalition

Women’s Health Coalition

Healthy Minds Coalition

Texas Oral Health Coalition

Texas Coalition for Healthy Mothers and Babies

Medical Orders for Scope of Treatment i

HEALTHY NURSE, HEALTHY NATION continued from page 9 Healthy Nurse, Healthy Nation™ is made possible in part by the generosity of the American Nurses Foundation and its sponsor Sage.

Reprinted with permission from the American Nurses Association. i

profession and benefit those we serve.

We are the largest healthcare workforce in Texas, and yet we struggle, at times, to find our voice. The voice we so anxiously search for is often found in the telling of our stories.

we bring to this passage called life. Our stories are the narrative of the professional Registered Nurse embedded in the greater chronicle of humanity. They are the glue that holds us together, and without them, we will surely be lost.

Each story is wonderfully unique, and each one a required component in helping others understand what it is that

Tell your stories. Shatter the labels. Walk home, together.

Peace, Jeff i

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Sandra Molina at: 877-469-6739 sandra.molina@angmarcompanies.com

We Serve Patients!

W I N T E R 2 017 | T E X A S N U R S I N G M AGA Z I N E

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

UNIFIED VOICES MEAN GREATER STRENGTH FOR YOU!

By Andrew Cates, Director of Government Affairs, Texas Nurses Association

Joining TNA to help accomplish nursing’s legislative agenda are the Nursing Legislative Agenda Coalition, the APRN Alliance, and the Coalition for Health Care Access.

THE 85TH LEGISLATIVE SESSION is upon us, and things are already heating up in Austin. The session runs Jan. 10 through May 29 — unless the Governor calls a special session. As announced by the Lieutenant Governor and Speaker of the House, the top priorities of this session are the state budget, the foster care system, the health care system, and some social issues like abortion and transgender rights.

nurses in Texas. NLAC is led by TNA, but we ensure that the voices of all members and organizations are included when we develop our agenda. We currently have 22 member organizations that represent a diverse range of interests from school nurses to emergency-care nurses. Our voice is stronger when we are unified under the same banner, and this coalition makes nurses more influential at the capitol than we’ve ever been.

The Texas Nurses Association (TNA) is already hard at work with our members, stakeholders, and legislators to make sure that you are represented and that the nursing profession is protected. On TNA’s agenda this session is the Board of Nursing Sunset review, APRN practice authority, nursing education funding and regulation, and workplace protections for nurses. Joining TNA to help accomplish nursing’s legislative agenda are the Nursing Legislative Agenda Coalition, the APRN Alliance, and the Coalition for Health Care Access.

The APRN Alliance has the same ideals and goals as NLAC: Unify our voices to be as persuasive at the Texas Capitol as possible. However, as the name suggests, the Alliance focuses only on APRN issues and is comprised only of organizations that represent APRNs. We are currently working towards full practice authority, greater signature authority, discharge prescription authority, and protecting the practice of APRNs in all roles and settings.

The Nursing Legislative Agenda Coalition (NLAC) is a coalition of nursing associations and advocacy groups from around the state who seek to improve the lives of

The Coalition for Health Care Access is a group of stakeholders with extremely broad interests that TNA and the APRN Alliance brought together to focus on one specific issue: full practice authority for APRNs. Texas lags behind nearly ev-

ery other state on unnecessarily restrictive barriers to APRN practice. Physicians use these barriers to practice to restrict and control competition. Unfortunately, this drives up costs and limits access for patients, especially for those who live in rural areas where physicians are impossible to reach. The Coalition for Health Care Access brings together members of the business community, veterans, senior citizens, faith-based organizations, and think tanks from both sides of the aisle to remove these outdated barriers to practice and allow APRNs to provide care to all populations in Texas.

TNA continues to work with all of these groups to achieve a common purpose for you: a better practice environment for nurses in Texas that produces better, more efficient care for your patients. i