President’s Perspective · Committee of the ANA Constituent Assembly (CA: is the group of the...
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current resident or Presort Standard US Postage PAID Permit #14 Princeton, MN 55371 Special Points of Interest: • Spring Meeting of the California Association of Colleges of Nursing ada CACN—Page 3 • RN Lobby Days—Page 4 • POLST Across the Continuum of Care— Page 6 ANA\C IS AN AFFILIATE CHAPTER OF THE AMERICAN NURSES’ ASSOCIATION Volume 16 • Issue 3 July, August, September 2011 President’s Perspective Elissa Brown Join the ANA\C Today! Information on page 11 Elissa Brown President, ANA\California Greetings from ANA\California: As you know, the good news is that nurses—YOU—are highly trusted professionals. With that trust comes respect and responsibility. How can we live up to that trusted image? We need to command/earn that trust in our every day work and in our lives. This includes a commitment to lifelong learning, to building our knowledge base and skills, staying current with local, state and national issues, knowing workplace systems and contributing to a healthy workplace environment. Although it is a topic we may wish not to discuss, “bullying in the workplace” has been in the news many times and sternly addressed by ANA. A related term is lateral violence. Many nurses face bullying as a part of their daily work environment. Karen Daley, President of ANA, recently spoke on the topic of “Bullying in the Workplace” at the National Nursing Ethics Conference held in the Los Angeles area. I shall discuss some of the key points Dr. Daley made, including how to identify bullying and strategies for dealing with it. She also discussed the fact that we have an ethical mandate “…in all professional relationships… to practice with compassion and respect for the inherent uniqueness and worth of every individual…” (ANA Code of Ethics for Nurses) Current literature identifies health care workers, including Nurses, as having the highest rate of workplace bullying. The Joint commission recently added a standard: Leadership Standard (LD.03.01.01) addressing disruptive and inappropriate behaviors/The CPI Workplace Bullying seminar. Some may be surprised at what constitutes bullying, and even more surprised that they are or have been the recipients of this negative behavior. Recognition, and “naming” it as bullying, are most important. What is bullying? One definition of “bullying” is: “Workplace bullying:” “repeated mistreatment: sabotage by others that prevented work from getting done, verbal abuse, threatening conduct, intimidation and humiliation.” (Source: The Workplace Bullying Institute). “Bullying” is also described as: anything that “constitutes offensive behavior through vindictive, cruel, malicious or humiliating attempts to undermine an individual or group of employees. These persistently negative attacks are typically unpredictable, irrational and unfair…they happen with great regularity within the workplace.” (source: Bullying and Intimidation,” Canadian Initiatives on Workplace Violence {2007}) Examples of bullying are: withholding information—including not sharing information about policies, procedures, rules, leading to an employee getting in trouble; intimidating others with threats of disciplinary actions; being yelled at, physically threatened in front of others; being sabotaged or assigned undesirable work; being belittled, or ignored; controlling staff through undesirable shift assignments; refusing to assist new staff; reminding people of incomplete work or documentation in front of others or in public memos. There can be a high cost to bullying, including physical and emotional problems, time off work, quitting work, increases aggression and violence in the setting, and the potential for affecting practice and safety. What can the nurse do? Interrupt the violence; face the perpetrator, get support; employers including nurse leaders have responsibilities to provide a safe workplace, a respectful open environment; encourage reporting (without repercussions for doing so); analyze the culture...promote necessary changes; provide education; teach about conflict management, support. We, nurses, as a group of such trusted professionals, must take responsibility to support a healthy work environment, free of bullying. We need to do our part for the sake of safe, high quality patient care and for the health of our colleagues and health of their work settings. Some Resources on Bullying: American Nurses Association’s 2006 House of Delegates Resolution: Workplace Abuse and Harassment of Nurses; American Nurses Association’s 2010 House of Delegates Resolution: Hostility, Abuse, and Bullying in the Workplace; ANA’s Workplace Violence Web page: www.nursingworld.org; ANA Continuing Education: Lateral Violence: Nurse Against Nurse http://www.nursingworld.org/mods/ mod440/lateralfull.htm; and OSHA’s Workplace Violence Web page: http://www.osha.gov/SLTC/workplaceviolence. A Future of Nursing Update: As you may know California is one of the first 5 states selected by Robert Woods Johnson to establish a Regional Action Coalition. The Statewide RAC and local groups, are working together to address nursing’s future in California. Taking the leadership, in our state, has been the California Institute for Nursing and Health Care (CINHC) led by Delores Jones. Nursing already had some structures in place, so we did not necessarily need to create new ones. ANA\California is very involved at different levels on committees and coalitions, and has strong representative leadership in the RACs, with two members in leadership roles, and others involved with the statewide RAC. There will be more opportunities. Nurses continue to lead the way. Other issues: ongoing issues continue with Health Care Reform; we shall keep you updated. There have been some bills addressing at least parts of health care reform and single party payer. Please check the American Nurses Association\California website and the American Nurses Association website: www.nursingworld.org for the latest information about, health care issues, healthcare reform and professional nursing issues. As Registered Nurses, we are a significant “caring” force in healthcare. I urge you all to look for opportunities and get involved; through work, professional associations, and community—at local, state and national—and even international levels. Sharing a bit about national and the ANA Constituent Assembly: I continue as a Vice-Chair of the Executive Committee of the ANA Constituent Assembly (CA: is the group of the Presidents and Executive Directors of all of the states plus a number of other constituents). We meet at least twice a year, sometimes “virtually” (via web technology). The CMAs also meet regularly on calls with President’s Perspective continued on page 8
Transcript of President’s Perspective · Committee of the ANA Constituent Assembly (CA: is the group of the...
current resident or
Presort StandardUS Postage
PAIDPermit #14
Princeton, MN55371
Special Points of Interest:
• SpringMeetingoftheCaliforniaAssociationofCollegesofNursingadaCACN—Page 3
• RNLobbyDays—Page 4
• POLSTAcrosstheContinuumofCare—
Page 6
ANA\C is AN AffiliAte ChApter of the AmeriCAN Nurses’ AssoCiAtioN
Volume 16 • Issue 3July, August, September 2011
President’s Perspective
Elissa Brown
Join theANA\C Today!Information on
page 11
Elissa BrownPresident, ANA\California
GreetingsfromANA\California:
Asyouknow, the goodnewsis that nurses—YOU—arehighly trusted professionals.With that trust comes respectand responsibility. How can welive up to that trusted image?We need to command/earn thattrust in our everydaywork andin our lives. This includes acommitmenttolifelonglearning,to building our knowledge baseand skills, staying current with local, state and nationalissues, knowingworkplace systems and contributing to ahealthyworkplaceenvironment.
Although it is a topic we may wish not to discuss,“bullying in the workplace” has been in the news manytimes and sternly addressed by ANA. A related term islateral violence. Many nurses face bullying as a part oftheirdailyworkenvironment.
Karen Daley, President of ANA, recently spoke onthe topic of “Bullying in theWorkplace” at theNationalNursingEthicsConferenceheld in theLosAngeles area.I shall discuss some of the key points Dr. Daley made,including how to identify bullying and strategies fordealingwith it. She also discussed the fact thatwe havean ethical mandate “…in all professional relationships…to practice with compassion and respect for the inherentuniquenessandworthofevery individual…”(ANACodeofEthicsforNurses)
Current literature identifies health care workers,includingNurses,ashavingthehighest rateofworkplacebullying.TheJointcommissionrecentlyaddedastandard:Leadership Standard (LD.03.01.01) addressing disruptiveand inappropriatebehaviors/TheCPIWorkplace Bullyingseminar. Some may be surprised at what constitutesbullying, and even more surprised that they are or havebeentherecipientsofthisnegativebehavior.Recognition,and“naming”itasbullying,aremostimportant.
What is bullying? One definition of “bullying” is:“Workplace bullying:” “repeated mistreatment: sabotageby others that prevented work from getting done, verbalabuse,threateningconduct,intimidationandhumiliation.”(Source: The Workplace Bullying Institute). “Bullying”is also described as: anything that “constitutes offensive
behavior through vindictive, cruel, malicious orhumiliating attempts to undermine an individualorgroupofemployees.Thesepersistentlynegativeattacks are typically unpredictable, irrational andunfair…they happen with great regularity withintheworkplace.”(source:BullyingandIntimidation,”Canadian Initiatives on Workplace Violence{2007}) Examples of bullying are: withholdinginformation—including not sharing informationabout policies, procedures, rules, leading to anemployee getting in trouble; intimidating otherswith threats of disciplinary actions; being yelledat, physically threatened in front of others; beingsabotaged or assigned undesirable work; beingbelittled, or ignored; controlling staff through
undesirableshiftassignments;refusingtoassistnewstaff;remindingpeopleofincompleteworkordocumentationinfrontofothersorinpublicmemos.
Therecanbeahighcosttobullying,includingphysicaland emotional problems, time off work, quitting work,increases aggression and violence in the setting, and thepotentialforaffectingpracticeandsafety.
What can the nurse do? Interrupt the violence; facethe perpetrator, get support; employers including nurseleadershaveresponsibilitiestoprovideasafeworkplace,arespectfulopenenvironment;encouragereporting(withoutrepercussions for doing so); analyze the culture...promotenecessarychanges;provideeducation;teachaboutconflictmanagement,support.
We, nurses, as a group of such trusted professionals,must take responsibility to support a healthy workenvironment,freeofbullying.Weneedtodoourpartforthesakeofsafe,highqualitypatientcareandforthehealthofourcolleaguesandhealthoftheirworksettings.
Some Resources on Bullying: American NursesAssociation’s 2006 House of Delegates Resolution:Workplace Abuse and Harassment of Nurses; AmericanNursesAssociation’s2010HouseofDelegatesResolution:Hostility, Abuse, and Bullying in theWorkplace; ANA’sWorkplace Violence Web page: www.nursingworld.org;ANA Continuing Education: Lateral Violence: Nurse Against Nurse http://www.nursingworld.org/mods/mod440/lateralfull.htm; andOSHA’sWorkplaceViolenceWebpage:http://www.osha.gov/SLTC/workplaceviolence.
A Future of Nursing Update: As you may knowCalifornia is one of the first 5 states selected by RobertWoods Johnson to establish aRegionalActionCoalition.TheStatewideRACandlocalgroups,areworkingtogetherto address nursing’s future in California. Taking theleadership,inourstate,hasbeentheCaliforniaInstituteforNursingandHealthCare (CINHC) ledbyDelores Jones.Nursing already had some structures in place, sowe didnot necessarily need to create newones.ANA\Californiais very involved at different levels on committees andcoalitions, andhas strong representative leadership in theRACs,with twomembers in leadership roles, and othersinvolved with the statewide RAC. There will be moreopportunities.Nursescontinuetoleadtheway.
Otherissues:ongoingissuescontinuewithHealthCareReform; we shall keep you updated. There have beensomebills addressing at leastpartsofhealth care reformandsinglepartypayer.PleasechecktheAmericanNursesAssociation\California website and the American NursesAssociationwebsite: www.nursingworld.org for the latestinformation about, health care issues, healthcare reformandprofessionalnursingissues.AsRegisteredNurses,weareasignificant“caring”forceinhealthcare.Iurgeyouallto look foropportunities andget involved; throughwork,professional associations, and community—at local, stateandnational—andeveninternationallevels.
Sharing abit about national and theANAConstituentAssembly: I continue as a Vice-Chair of the ExecutiveCommittee of the ANA Constituent Assembly (CA: isthe group of the Presidents and Executive Directors ofall of the states plus a number of other constituents).Wemeetatleasttwiceayear,sometimes“virtually”(viawebtechnology).TheCMAsalsomeetregularlyoncallswith
President’s Perspective continued on page 8
Page 2 • ANA\C The Nursing Voice July, August, September 2011
Inside this issue:
Presidents Perspective 1
Spring Meeting of the CACN 3
RN Lobby Days 4
APRN Summit 5
Nursing Students in Sacramento 5
POLST Across the Continuum 6
Golden State Nursing Foundation 10
ANA\C General Assembly 10
Membership and Communication 11
www.anacalifornia.org
ANA\C Wants To See You….IN THE NEWS
Have you or one of your colleagues been recognizedfor an accomplishment, elected to office, won an award,received a grant or scholarship, launched a new venture?Tell us about it!Sendname, address, phonenumber, andaccomplishment—
E-mailto: [email protected]: ANA\CaliforniaINTHENEWS 1121LStreet,Suite409 Sacramento,CA95814
Article Submittal to ‘The Nursing Voice’
ANA\California accepts and encourages manuscriptsand editorials be submitted for publication in theassociation’squarterlynewsletter,TheNursing Voice.Wewill determine which letters and articles are printed bythe availability of publication space and appropriatenessof the material. When there is space available, ANA\Cmemberswillbegivenfirstconsiderationforpublication.Wewelcomesignedlettersof300wordsorless,typedanddoublespacedandarticlesof1,500wordsorless.ArticlesprintedinTheNursing VoicedonotnecessarilyreflecttheviewsofANA\C,itsmembership,theboardofdirectorsoritsstaff.
ANA\California’sofficialpublication,‘TheNursing Voice’ editorial guidelines and due dates for articlesubmittalisasfollows.
1. Manuscripts should be word processed anddouble-spacedonone sideof8½x11 inchwhitepaper.Manuscripts should be emailed toEditor [email protected]
a. Manuscripts should include a cover page withtheauthor’sname,credentials,presentposition,address and telephone number. In case ofmultiple authors, list the names in order inwhichtheyshouldappear.
b. TheNursing Voicereservesone-timepublicationrights. Articles for reprint will be accepted ifaccompaniedwithwrittenpermission.
c. The Nursing Voice reserves the right to editmanuscriptstomeetstyleandspacelimitations.
d. Manuscriptsmay be reviewed by the EditorialStaff.
e. Articlessubmittedbymembers’ofANA\Cwillbe given first consideration when there is anavailabilityofspaceinthenewsletter.
2. Photographs should be of clear quality. Writethe correct name(s) on the back of each photo.Photographswillbe returned ifaccompaniedbyaself-addressed,stampedenvelope.Mailphotographsto: Samantha Hunter, Editor, The Nursing Voicec/o ANA\California, 1121 L Street Suite 409,Sacramento CA 95814. Or email photographs [email protected]
AmericanNursesAssociation/CaliforniaisanAffiliateChapterMemberoftheAmericanNursesAssociation.
The Nursing Voice istheofficialpublicationoftheAmericanNurses’Association\California.
ANA\Cislocatedat1121L.Street,Suite409Sacramento,CA95814,
Office916-447-0225-Fax916-442-4394AssociationE-mailanac@anacalifornia.org
TheNursing [email protected]
ANA\CBOARDOFDIRECTORSOfficers:ElissaBrown,MSN,PMHCNS-BC,President;Elizabeth“Liz”Dietz,EdD,RN,CS-HP,VicePresident;NicoleMarcy,BPH,BSN,RN,Secretary; Cathy Melter, RN, MSN, CWOCN, Treasurer.Directors; Monica Weisbrich, BSN, RN, Legislative andProfessional; Donna Dolinar, RN, BSN, MPA(c), Practice;Dianne Moore, PhD, RN, CNM, MN, MPH, Education;Arlene R. Hady, BSN, RN, PHN, Membership andCommunication.
ANA\CaliforniaExecutiveDirector: Hon.TriciaHunter,MN,RN
ANA\CAssociateDirector: MyrnaAllenMSN,RN
ANA\CaliforniaLobbyingFirm: GovernmentRelations Group,Inc.
ANA\CDirectorofMemberServices SamanthaHunter
ANA\CMerchandiseDevelopment&Sales MicheleTownsend
EditorialCommittee:Chairperson LouiseF.Timmer,EdD,RNStaff Hon.TriciaHunter,MN,RN SamanthaHunter
The official publication of the ANA\C shall be The Nursing Voice. The purpose of this publication shall be to support the mission of ANA\C through the communication of nursing issues, continuing education and significant events of interest. The statements and opinions expressed herein are those of the individual authors and do not necessarily represent the opinion or views of ANA\C, it’s staff, the Board of Directors, our Affiliates or the publications editors. Likewise, the appearance of advertisers, and/or their views and opinions, do not constitute an endorsement of products or services featured in this, past or subsequent issues of this publication. CopyrightbytheAmericanNursesAssociation\California.
TheNursing Voice ispublishedquarterlyeveryJanuary,April,July and October and is complimentary to ANA\C members,schools of nursing and their nursing students, affiliates of theassociationandtheirmemberships.Ifyouwouldliketosubmitanarticleforpublication,pleasesee‘ArticleSubmissionforTheNursingVoice’inthisissuefordeadlinesandsubmissiondetails.
Ifyouwouldliketoreceivethis publicationoryouwouldliketostop receivingthis publicationpleasewriteorcalltheANA\Cat (916) 447-0225 or fax to (916) 442-4394. Please leave yourfullname,completeaddressoraddresscorrectionandaphonenumbershouldweneedtocontactyou.Or,filloutandmailintheUpdateRequestFormfoundinthisnewsletter.
Reprints and Submissions: ANA\C allows reprinting ofnewslettermaterial. Permission requests should be directed totheANA\ChomeofficeinSacramento.(916)447-0225
Advertising: Advertising Rates Contact—Arthur L. DavisPublishingAgency,Inc.517WashingtonSt.,POBox216,CedarFalls,IA50613,800-626-4081,[email protected]\CandtheArthurL.DavisPublishingAgency,Inc.reservetherighttorejectanyadvertisement.Responsibilityforerrorsinadvertisingis limited tocorrections in thenext issueor refundofpriceofadvertisement. Acceptance of advertising does not implyendorsementorapprovalbyANA\Cofproductsadvertised,theadvertisers, or the claimsmade.Rejectionof an advertisementdoesnotimplyaproductofferedforadvertisingiswithoutmerit,or that themanufacturer lacksintegrity,or that thisassociationdisapprovesoftheproductoritsuse.ANA\CandtheArthurL.Davis PublishingAgency, Inc. shall not be held liable for anyconsequences resulting frompurchaseoruseofanadvertiser’sproduct.
July, August, September 2011 ANA\C The Nursing Voice • Page 3
Spring Meeting of the California Association of Colleges of Nursing aka CACN
Dianne S Moore, PhD, MPH, CNM, RNDirector of Education ANA\C
Associate Provost for Nursing,West Coast University
Every spring in late April the CACN meets to discussissuesofinteresttothecollegesanduniversitiesofnursinginCalifornia.ThisyearthemeetingwasinSacramentoandwasco-hostedbyACNL.ThetopicsdiscussedoverthetwodaysoftheconferencerangedfromtheInstituteofMedicines(IOM)reportontheFutureofNursing,thecurrentlegislationbeforetheCalifornialegislature,tohottopicssuchastheachievementoftheIOMrecommendationof80%ofnurseshavingaBSNand doubling the number of nurseswith a doctorate by theyear2020.
AB661, the bill currently before the legislature to allowthe California Community College system to award a BSNdegreewasdiscussedaswellastheimpactofthebill tothecurrentBSNandELM(entrylevelmasters)programswithinthecurrent fouryearcollegesanduniversities.Overall, therewassupportforthevariouswaysnursescouldobtaintheBSNor higher degrees. However, there was concern about thebest method to offer BSN education without compromisingthe quality of the BSN degree. There was discussion aboutwhat itwould take to incentivize nurseswho currently holdan ADN to move forward toward the BSN degree. Sincethere are many new programs that offer the RN to MSNdegree, this educational pathway was encouraged as a wayto meet the BSN objective and increase the number ofnurseswithgraduatedegrees.CACNencouraged its clinicalpartners to findways to incentivizenurses tomeet the IOMrecommendations including getting the BSN and becominglifelonglearners.
Alongthelinesofnursingeducation,adiscussionoccurredabout the increasingdifficulty toobtain the typesofclinicalexperience the students need to become competent novicepractitioners upon graduation. More and more facilities arerestricting students access to such experiences as PYXISmachines, dispensing controlled substances, giving IV
medication, hanging blood, participating in codes usingglucometers, communicating with physicians and otherhealth care professionals. In addition, nursing students arerequestedtoleavewhenthereisanytypeofaccreditationorapprovalvisitfromanyagency.Themixtureofthesevariouslimitations or outright denial of admittance to the facilitiesmakesprovidingadequateclinicalexperiencemoreandmoredifficult. Our clinical partners must understand the impacttheserestrictionsandlimitationsarehavingonnewgraduateswhoarepreventedfromlearningbasicskillsandcompetenciesnecessary for nursing practice. It is essential that nursingstudents have adequate learning experiences in hospitals topreparethemfortheirfirstnursingposition.Nursingprogramshave approximately 900-1200 hours to teach the clinicalskills needed to become safe practitioners. This timeframeislessthanhalfayearwhichcertainlydoesnotgivethenewgraduate sufficient time to“hit theground running” in theirfirstnursingposition.Eachrestrictionfromafacilitycutsintothevaluablelearningtimefornursingstudents.
Thesecondmajor topicdiscussedat themeetingwas thenursing doctorate and the IOM recommendation to doublethe number of nurses with doctorates by the year 2020.Informationwaspresentedabout thecurrentDNP(doctorateof nursing practice) program in California, which currentlyare all in private universities such as USD, USF, WesternUniversityofHealthSciences,andSamuelMerrittUniversity.Thereishopethatthiswillchangeinthenearfuturewiththeadventof thedemonstrationprojects for theCaliforniaStateUniversitysystems.DiscussionoccurredaboutthedifferencebetweenthePhDandotherprofessionalandpracticedoctorateintermsofacceptanceinsomeuniversitiesregardinghiring,rankingandpromotionoffaculty.TheDNPasatitleforthedoctorateinnursingpracticedegreehasbeenaroundforover30years(calledtheDNSc,NDandthelike)andisinthesamecategoryofprofessionalpracticedegreessuchastheJD,MD,EdD,DPT,DMDorDDS,DDiv.Theseprofessionalpracticedoctoraldegreesaregenerallyacceptedforranking,promotionandtenureintheuniversitysetting.
One clarification to keep in mind is that the DNP is
NOTadoctorateofnursepractitioner.Thedoctorofnursingpractice degree is not related to certification or licensing asan advanced practice registered nurse such as a certifiednurse practitioner (CNP), certified nurse specialist (CNS),certified nursemidwife (CNM) or certified registered nurseanesthetist (CRNA). The advanced practice doctoral degreecanbeinotherfieldsofnursingpracticesuchasinformatics,administration, and genetics. The AACN (AmericanAssociationofCollegesofNursing)hasrecommendedthattheAPRNeducationbemovedtothedoctorallevel;totheDNPby2015.ItisimportanttorememberthereareotherareasofnursingthatareawardedtheDNPdegreeotherthanthefourcategories (CNP, CNM, CRNA, NP) of advanced nursingpractice.
Other topics of interest is the new website and servicesrelated. The new site is www.cacncalifornia.org and it hasa section for job postings, events, updates on education andpractice. Another point of interest to the nursing educationsettingisthechangeinthenumberofscholarshipsavailable.There is a $13,000 scholarship available but the applicationperiod is limited to the fall timeframe. Students areencouragedtoapplyastherehavebeenfewapplicantsoverthepastfewyears.Facultyareencouragedtoassiststudentsintheapplicationprocessasthisincreasestheirchancesofsuccess.Theprivateuniversitieswishtoremindpeoplethattheprivateschoolseducateabout50%oftheBSNgraduatesinCaliforniaandareagood investment inyour future.Theydonothavethe same financial issues as the state schools do and oftenhavescholarshipsorloansprogramsavailabletothestudentsquicklywhetheritisforthegenericBSNortheRNtoBSNorRN-MSN,MSNorDNPprogram.Therearealsomanyloanforgivenessprogramsavailableforstudentstoapplyto,whichwouldreduceoreliminatetheirdebt.
Therewereavarietyofother topicsof interestbut this istheessence.PleasekeepintouchformorenewsaboutnursingeducationinCalifornia.ANA\CalsoencouragesmembershipinANAandANA\Candwiththatcomesfreeaccesstoeachof theDivisions of Education, Legislation,Membership andmorewhichwillkeepyouintouchwiththehappeningswithinyourstate.
Page 4 • ANA\C The Nursing Voice July, August, September 2011
RN Lobby DaysDidyouknowthat therearearound385,000nurses in
the state of California, in many aspects and capacities.There are roughly 40 Senators, and 80 Assembly menandwomen that aremaking all of the choices regardingyour profession. These people decide what constitutes asafework place, howmany hours that nurseswork, howyoucanorcannottreatyourpatients,andhowmuchpowerthe insurance companies can have. They decide fundingfor research, healthcare for the employees, aswell as thepatients, funding for nursing education, and rules andregulations about situations that they can only picture intheirheads.Didyoualsoknowthatthose40Senatorsand80Assemblypeoplerelyalotontheexpertiseofthosethatare in the profession to guide them on how they shouldvote on issues, and what issues need to be addressed.RN Lobby Days is an important, educational and eye-openingevent thatwasdesignedandishostedeveryyearby the American Nurses Association\California. Ourmain goal is to educate Nurses, Nursing Students, andNursingEducatorsontheimportanceofyourinvolvementwithnotonlyyourprofessionalassociation,butwithyourgovernmentatwhateverlevelyourcausedeemsnecessary.
RN Lobby Days this year was structured a littledifferentlythaninthepast.ItwasaonedayeventthattookplaceatourStateCapitol,inSacramento.Untilyou’vegoneto this convention and listened to the speakers, andwhattheyhave to say,you reallyhaveNOIDEAhowexcitingand important this information is! Tricia Hunter, theExecutive Director of ANA\C, former Assemblywoman,and a surgical nurse,was the keynote speaker. Shedid afantasticjobexpressingtheimportanceofourinvolvement
and how much of an influence each of us can be, bothindividuallyandasagroup.AsI’vesaidinthepast,Ineverthoughtthatmedicineandpoliticshadanythingtodowitheach other. I had also never thought about the fact thatthereareonlyahandfullofpeople,comparatively,makingallof thedecisions regardinganyandall lawspertainingto the nursing profession (and any other issue you feel important). Because of this,medicine and politics do, infact, unite. As many of you know, that’s where ANA\Ccomesin.ANA\Cisthelegislativeconnectionbetweenthenursing profession and the political body thatmakes thefinaldecisionsonsafety,personalrightsforthepatientandmedical personnel, liability, and all other aspects of thishonorable profession. RN LobbyDays is the educationalconnection that teaches the nurses ofCalifornia not onlywhyitisimportantthattheybeinvolved,buthowtodosoeffectively.
As with every year, the people that attended RNLobbyDays,cameinunawareofwhattoexpect.Itseemsmost were expecting a long and boring day. Some weredisappointedbecause theylearnedfirst-handhowquicklythings change in that building, when the health relatedcommittee meetings that were scheduled for that dayweresuddenlyrescheduledforadifferentday.Butaswitheveryyear,mostweresurprisedandexcitedtofindoutnotonlyhowimportantitisthatpeoplegetinvolved,buthoweasyitistodoso.Thereare,ofcourse,someprotocolstofollow,butby theendof theRNDaysexperiencepeoplewere familiar and comfortable with those protocols.Remember, our legislators are people too, and they trulyaretheretohelpmakeourstateabetterplace.Yourinput
does matter. There are now more than 150 additionalnursesand futurenurses that areequippedwith the toolstoactivelyassistyourprofession,andourlegislature.Yousee,the more people that realize how important is to give the political officials an accurate picture of nurseswants,andneeds, thebetterserved thewholenursingprofessionwill be.We’d like to thank all that attended RN LobbyDays 2011, and encourage each of you to attend futureRNLobbyDays.The legislativeprocessmaynotchange,but the issues will, and therefore it is likely that yourinvolvementwillbe justas importantas it is today.Afterall, what better way is there to improve your profession,thantobeapartofthechangeyouwouldliketosee?
July, August, September 2011 ANA\C The Nursing Voice • Page 5
Report from Elissa Brown
On April 30th, 2011, the California APRN SummitGroup met in San Pedro, California at the lovelyCommunity Center at Fort MacArthur. Some history oftheAPRNSummit:thefirstSummittypeofmeetingwasconvened about 4 years ago by ANA\C and its affiliate,CAPNAP (the California Association of Psych\MentalHealth Nurses in Advanced Practice). Since then, theyheld a number ofmeetingswith representatives from thefour advancedpractice nurse groups,CACNS (CaliforniaAssociation of Clinical Nurse Specialists, CANP(California Association of Nurse Practitioners), CANA(California Association of Certified Nurse Anesthetists)and CANM (California Association of Certified NurseMidwives). In addition, school nurses and nurses fromthe California Board of Registered Nursing, hospitals,and nursing programs attended the meetings. Thisgroup developed aWhite Paper addressing the Future ofAdvanced Practice Nursing in California. The Summitmeeting inSanPedro served tobring thenursinggroupsback together formore strategic planning and to finalizetheirWhitepaper.
by Bret Barrett
I have nursemares with increasing frequency as Iapproachmygraduation.There’stheonewhereIfindmydegreewasn’tenoughtopracticeasanurse.IwakewithastartafterdreamingofthepatienttowhomIadministeredadrug,onlytofindoutitwasoutsidemyscopeofpractice.Evenmore common, are those nursemares involvingmychildrenreceivingcarefromunlicensedschoolpersonnel.In the morning, I realize they are simply nightmaresbecausethereisnowaythesecouldbecomereal.
Unfortunately, each of these nightmares could cometrue. Any scary scenario you could imagine in yourpractice has probably been presented in our capitol.Fortunately, the nurses in Sacramento who advocate forourpracticeareverygoodattheirjobs.
I recently was awarded the Nursing Student inSacramento Internship for 2011 and had the pleasureof spending three days with these nurse advocates. InpartnershipwiththeCaliforniaStudentNurse’sAssociation(CSNA)and theAssociationofCaliforniaNurseLeaders(ACNL), the American Nurses Association of California(ANA/C)hostedtwostudents,EmilyJacksonandmyself.Together we participated in RN lobbying days, workingwith those influencingpolicy inour state.For threedaysweworked tirelesslywith those nurseswho advocate forourcorevalues.
Two of the important issues this week had to dealwith medication administration. Diastat, a gel form ofValiumgivenrectallyforseizures,isbeingproposedtobeadministered by volunteerswith nomedical background.The bill would require each volunteer, with limitedtraining and no educational requirement, to use nursing
APRN Summit—April 30, 2011Our Keynote Speaker at the April Summit meeting
wasLizSummers,SeniorPolicyFellowat theAmericanNurses Association. She did an excellent and thoughtprovoking jobofdiscussingpolicyandadvancedpracticenursingfromanationalperspective.TheHonorableTriciaHunter, our ANA\C Executive Director, discussed thecurrent political climate and happenings in California.Garrett Chan, spoke as the recently appointed Chair forthe IOM/RWJ California Regional Action CommitteeRecommendation #1. This recommendation advocatesfor advanced practice nurses to practice to the fullestextent of their education, training, and (practice) and toremovethebarrierstothescopeofpractice.Hediscussedhow ourAPRNSummit group, as a structure already inplace,hasbeenandcouldcontinuetobethegrouptolookat recommendation #1 for advanced practice nurses. Thegroupwas in agreementwith his advice.Garrettwill begatheringdataandworkingcloselywiththegroup.
Itwasaveryproductiveday.Thenetworkingisalwaysworthwhile; we learn so much from one another. It isrefreshingandpositivetohavethisgroupofAPRNswhoare trulyworking together towardachievingourcommongoals.
Nursing Students in Sacramento Internshipprocess to determine appropriateness of administration.These volunteers would not come from school nurses,LVNs, or even teachers, but bus drivers, teacher’s aides,and school secretaries.Although theANA/Cwas unableto stop the bill in committee, the members are alreadyformulatingplansforthenextstepsintheprocess.
Propofol, a drug on everybody’s mind since MichaelJackson’sdeath,hasaclearcaselawasananesthesiadrug.However,manyhospitals are askingnurses to administerthe prescription. TheBoard ofRegisteredNurses (BRN)recently issuedconflicting statements, from twodifferentmembers, on where this falls in scope of practice. TheANA/C is working with the BRN to create a statementto clarify which medications fall under normal scope ofpractice and which are reserved for anesthesiologists orCRNAs.
In both of these cases I had the opportunity toparticipate in the process. We went around and lobbiedfor the safety of school children. Discussed and debatedthe merits of the legislation. Researched case law andalternative methods. We were even able to give ouropinion in front of the State Senate’sHealthCommittee.TheimmersionintotheprocesstaughtmemorethanafullsemesterofLeadershipclass.
Thank you to the ANA/C for hosting me this week.Additionally, thank you to the CSNA and the ACNLfor awarding me with such an honor. The experiences Ienjoyed these three days will stay with me throughoutmycareer.Iamexcitedtoadvocateatalllevels,frommyindividualpatient to thehighest levelsofgovernmentandencourage all nurses to use their influence to promotebeneficialchange.
Page 6 • ANA\C The Nursing Voice July, August, September 2011
POLST Across the Continuum of CareAnother in a series of articles specifically on nursing
and POLST. Thank you to the Coalition for Compassionate Care of California (CCCC).
Elissa Brown, President, ANA\C
Kate O’Malley, RN, MS, Senior Program Officerat the California HealthCare Foundation
California’s nurses are hard at work implementingan innovative tool called the Physician Orders for Life-Sustaining Treatment (POLST) to help patients expresstheirend-of-lifewishes.
POLSTisamedicalorderformsignedbyapatientandhisorherphysicianthatspecifiesthepatient’spreferencesregarding Cardiopulmonary Resuscitation (CPR),hospitalization, and treatments like antibiotics, feedingtubes, and other medical interventions. Produced ondistinctivebrightpinkpaper,POLSTtravelswithpatientsas they move from one residential or medical setting toanother and keeps providers informed of their patients’wishes.
NurseshaveacriticalroleinensuringthatseriouslyillpatientsareawareofPOLSTandunderstandtheavailabletreatmentoptions.Theyalsohavetheopportunitytoworkwith other providers to ensure POLST formsmove withpatientsacrosscaresettings.
“NurseshavebeenstrongleadersintheuseofPOLST,helpingpatients tomake theirwishesknown,” saidBettyFerrell,RN,PhD,MA,FAAN,FPCN,aresearchscientistatCityofHopeinDuarte.“POLSThelpsnursesnavigatecomplex care situations and ensures that patients receivecarethathonorstheirdignity.”
But nurses can’t do it alone.“POLST includes participation from a patient’s entire
medical team,” said Joanne Hatchett,MSN, RN, FNP, afamilynursepractitionerfortheWoodlandClinicMedicalGroup and project director for the Yolo County POLSTProject. “Doctors, nurses, chaplains, and social workersall work together to have the POLST conversation withpatients.”
It’s often helpful to begin the conversation by talkingwithpatientsaboutthethingsthatareimportanttothem.
Hatchett, for example, had a patient who enjoyedwatering plants and playing with his grandchildren. Hehadbeenonaventilatorwhenhisphysician talkedaboutinserting a tracheotomy tube, but Hatchett asked thephysicianwhetherhavingthetubewouldallowthepatientto do the things he loved.When the doctor said no, theman chosenot topursue theprocedure. If it didn’t allowhimtospendmoretimedoingthethingsthatmatteredtohim,hedidn’tseeanyreasontohavethetracheotomy.Soinstead, he asked his physician to remove the ventilator,andhespenthisfinaldayscomfortablywithhisfamily.
POLST conversations can occur across the continuumof care. An ideal time to discuss a patient’s wishes isoutside of the acute care setting. It’s preferable to havethese conversationswhenpatients are not facing a health
crisisandcanthinkaboutwhattheyreallywantandmakean informed decision. Ongoing office appointments,for example, present a good opportunity to facilitateconversations about a patient’s preferences for end-of-lifecare.
“Theconversationdoesn’thavetoalltakeplaceduringone visit,” said Chris Evans, MSN, RN, an educator forCatholic Healthcare West in Sacramento and chair oftheSacramentoAreaPOLSTCoalition. “It’s not an easyconversationtohave,butit’simportanttostartdiscussinggoalsforend-of-lifecare.”
A POLST form may be changed by a patient at anytime. If after completing their POLSTs, patients have achangeofheartabout thekindofcaretheywouldliketoreceiveortheirhealthconditionchanges,theycanalwaystalkwith their providers to complete a new POLST. Forexample, initially a patientmay choose to haveCPRandlong-termtubefeeding.However,ifhishealthdeclines,hemightdecidethathenolongerwantsthesetreatmentsandcancompleteanewPOLSTform.
“ThebeautyofPOLSTisthatitcanalwayscontinuetobechanged,”saidEvans.
To ensure that the POLST form moves with patientsacross the continuum of care, nurses can educate theirpatients about the portability of POLST. A nurse caninstruct a patient living at home, for example, to keepthePOLSTformnear thebedoron the refrigeratordoorbecausetheseare thelocationswhereemergencymedicalpersonnel will look for a POLST form. Nurses can alsoencouragepatientsandtheirfamiliestotaketheirPOLSTform with them to medical appointments or the hospitalandalwaysprovideittoemergencyresponders.
IfapatientcompletesaPOLSTwhileinacarefacility,nurseshave theopportunity toensure that the formstayswith thepatientswhenmoving to another care settingorreturninghome.
“POLST belongs to patients,” said Evans. “Somefacilities already include in their policies that POLSTformsshouldbe treated likeapatient’spersonalpropertyandmustbetransferredwiththepatientwhentheychangehealthcaresettings.”
Acute Care FacilitiesSome patients come to acute care facilities without
a POLST, while others already have a POLST formcompleted.
IfaPOLSThasbeencompletedbeforeapatientarrivesatanacutecare facility,anursemightbe the first to seetheformandneedstodeterminewhetherthePOLSTformis current and filled out correctly. If it is, the nursewillworkwithphysiciansandothermedicalstafftocarryoutthepatient’swishes.
On the other hand, if a patient enters the hospitalwithout a POLST, there may be an opportunity to havethe POLST conversation, especially if the patient wasjust diagnosedwith a life-limiting illnessor if a chronic,progressive illness has become more severe. Bedsidenurses have an especially important role to play, because
they spend so much time with their patients and canexplorethepatient’swishesandgoalsofcare.
“Doctors often ask patients and their families ifthey have any questions, but people are either toooverwhelmedtoaskortheythinkofaquestionlater,”saysJackie Kimball, RN, palliative care coordinator for St.BernardineMedicalCenter in SanBernardino. “In thosecircumstances, nurses are the best source of informationaboutend-of-lifechoices.”
If a hospital has a palliative care team, they can alsobe a resource for nurses having a POLST conversation.These teams are trained in discussing importantmedicaldecisions,andunderstandthe importanceofbeinghonestwithapatientabouttheirsituation.
Skilled Nursing FacilitiesSkilled nursing facilities are another location where
patients could benefit from a conversation about end-of-life care, as many residents have multiple, complex, andprogressivemedicalconditions.
“Somepatientsare readier thanothers todiscuss theirsituations,soitcantakeseveralconversationstocompleteaPOLSTform,”saysDeborahPatricio,RN,BSN,CCM,directorof inpatientservicesforMonarchHealthcareandco-leadof theOrangeCountyPOLSTCoalition.“Nursescanstartbydoingsomepreliminarydetectiveworktogeta sense of the patient and family, and then they can seehowPOLSTfitsintothepatient’sestablishedvalues.”
HospiceWhenapatientbeginshospicecare,nurseshaveanother
opportunitytohavethePOLSTconversation.“POLST gives patients and their families peace of
mind,” said Pam Young, RN, a clinical educator forHoffmannHospice inBakersfield.“It facilitatesdecision-making and allows for conversations about end-of-lifecare.”
Whetherpatientsarereceivinghospicecareathomeorin a facility,Young has found thatmost patientswant toexpresstheirwishes.
“It’sveryraretohavepatientswhocan’tmakechoicesafter discussing their end-of-life care,” saidYoung. “Andif patients aren’t quite ready, they can think about theirwishesanddiscussthemagainlater.”
NomatterwhatthesettingforthePOLSTconversation,nursesshouldbepreparedtotakethetimetolistenandbeopentotalkingaboutoptionswiththeirpatients.
“Whenpatientswant to tell someone theirwishes, it’sourjobtolistentothem,”saidPatricio.“Theyseenursesas their advocates, and so they often feel comfortabletalkingwithus.”
Your Care SettingIfPOLSThasnotyetbeenimplementedinyourclinical
setting,thefirststepistobringit totheattentionofyourmedicaloradministrativeleadership.
“It is important to bring POLST to your colleagues’attention and help them understand its advantages,”said Kimball. “As advocates, we’re always looking foropportunities to improve our patients’ care. That’s whatPOLSTis,andthat’swhyI’msuchabelieverinit.”
To learn more about POLST, you can visit theCaliforniaPOLSTwebsiteatwww.caPOLST.org.Youcanfind information on POLST efforts in your area, aswellasthecontactinformationforPOLSTadvocatesacrossthestate.TheCoalitionforCompassionateCareofCalifornia(CCCC) also offers train-the-trainer courses to helporganizationsandcoalitionsinitiatingPOLSTprogramsintheirfacilitiesandcommunities.
July, August, September 2011 ANA\C The Nursing Voice • Page 7
Page 8 • ANA\C The Nursing Voice July, August, September 2011President’s Perspectives continued from page 1
theANAPresident. Ishallstrive toupdateyouabout theissuesthatweaddressonbehalfofANA\California,otherstatesandANA.
Thankyouagain, toourmembers, toourveryreliableANA\California Board members and staff who do theirbest,workhard,promotequalityhealthcareforthepublic,participate in healthcare reform and support theNursingprofession,ANA\CaliforniaandANA;andtoallnurses.
Please do join us for the following (please see ourwebsiteformoredetails):
ANA\C GENERAL ASSEMBLYSaturday, October 29th, 2011
at West Coast University, Ontario, CA
Karen Daley, ANA Presidentwill be our
Keynote speakerPlease see flyer on our website.
Wewelcomeanycomments,questionsandsuggestions.
Nurses Step Forward: ANA/C
Practice CommitteeThe 2011-2013 ANA\C Practice Committee term
has just begun and I would like to extend an invitationto nurses who are interested in participating and have aspecial interest in practice issues. The purpose of thiscommitteeistoprovideinputtothelegislativecommitteeregarding nursing practice issues, identify priority issuesthat affectnursingpractice inCalifornia, and reviewanddevelopANA\Cpositionsrelatedtonursingpractice.
This committee is currently conducted by e-mailinteraction. As director, I correspond in a monthlynewslettertomembersontopicsofinterestandencouragedialogue between members on all topics.When practiceissuesorcomment isneededonan issue,correspondencewill go to members throughout the month. PracticeCommittee members may bring questions and topics ofconcerntothecommitteeasneeded,atanytime.
TheANA\CPracticeCommitteeconsistsofRNsfromvaried backgrounds and levels of experience. We are adiversegroupofnurses fromdifferentpractice areas andofferavaluablevoice.
If you are interested in participating, [email protected].
Board of Registered NursingDiversion/Probation Department1625 N Market Blvd., N217Sacramento, CA 95834
Contact: Millie LoweryPhone: 916-574-7619
For more informationVisit our website at
www.rn.ca.gov
July, August, September 2011 ANA\C The Nursing Voice • Page 9
Page 10 • ANA\C The Nursing Voice July, August, September 2011
Membership Form for the Golden State Nursing Foundation
Yes,IwouldliketobecomeaFriendoftheGSNFandreceiveemailedandmailedupdatesastothefoundationsprojectsandevents.
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Golden State Nursing Foundation (GSNF) AMERICAN NURSES ASSOCIATION\CALIFORNIA
GENERAL ASSEMBLYDate: Saturday, October 29, 2011
Place: West Coast University • Ontario, CaliforniaTime (tentative): 9:30 am-4:30 pm
Agendaincludes:• Keynote:KarenDaley,PresidentofANA• ContinuingEducationSession:LearningthroughSimulation• IntroductionoftheANA\CBoard• Businessmeeting,BylawsandResolutionsdiscussionandvoting• SilentAuctionandDoorPrizes• Opendiscussion
*Moreinformationwillbesentinthecomingmonths.Welooktoforwardseeingyouthere.- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
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July, August, September 2011 ANA\C The Nursing Voice • Page 11
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e-mail address?
YoucanhelpAmericanNursesAssociation\California‘stay in touch’ by updating your contact information.Call ANA\C at 916-447-0225, e-mail us a [email protected]:
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