Vol. 86 • Number 4 November, December 2017, … · donelle.richmond@Nicole Scherr Sherry Burg,...

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Vol. 86 • Number 4 November, December 2017, January 2018

I Choose to Be Grateful

President’s Message

Tessa Johnson

Tessa Johnson, MSN, BSN, RN

“Tis the season,” right; it is hard to believe that we have made it through yet another year and 2017 is in its final months. This year, we as nurses in the state and throughout the country, have seen a lot happen and we have been through a lot in health care. We have focused on the health of our nation and the health of our nursing workforce with our healthy nurse, healthy nation campaign. So often we roll into the New Year with new goals, new hopes and new plans. Although I do think that is important, this year I am going to take the time to reflect on what good things impacted my life in 2017 and what I can be grateful for; I challenge you all to do the same thing.

By reflecting on what we are grateful for as nurses, moms, dads, brothers, sister, husbands and wives we are able to bring more joy to our loves and the lives around us. According to Brooks 2015, “It is relatively easy to be thankful for the most important part of life – a happy marriage, healthy kids or living in America. But truly happy people find ways to give thanks for the little, insignificant trifles.” If you think about those “insignificant things” in your life and find the good in them, I believe you make a substantial difference in your own happiness. As we know with the healthy nurse, healthy nation campaign in order to help our patients we have to help ourselves first. If we as nurses can make an honest effort to be grateful for the little things, we can also instill that in our patients.

I would like to challenge the nurses in the state to find your gratitude as you close the 2017 year and look forward to what 2018 will bring to your life. One easy thing to start with is keep a journal.

Establish a daily exercise in which you remind yourself of the gifts, grace, benefits, and good things you enjoy. Setting aside time on a daily basis to recall moments of gratitude associated with regular events or valued people in your life gives you the potential for more gratefulness. It is also important to remember the bad. To be grateful in your current state, it is helpful to remember the hard times that you once experienced. When you remember how difficult life used to be and how far you have come, you set up an explicit contrast in your mind, and this contrast is fertile ground for gratefulness (Emmons, 2010).

If you can all agree to end this year and to start the next year by choosing gratitude and happiness, I believe we can make a significant impact as nurses in the lives of our families and our patients. I also want to wish you all a joyful holiday season and look forward to having you all with us in 2018. I want to add that I am personally grateful for all of the wonderful nurses in ND; be well, we need all of you!

ReferencesBrooks, A. C. (2015, November 21). Chose to Be

Grateful. It Will Make You Happier. The New York Times. Retrieved September 13, 2017, from https://mobile.nytimes.com/2015/11/22/opinion/sunday/choose-to-be-gratful-it-will-make-you-happier.amp.html

Semmons, R. (2010, November 17). 10 Ways to Become more Grateful. The Greater Good Magazine. Retrieved September 13, 2017, from https://greatergood.berkeley.edu/article/item/ten_ways_to_become_more_grateful1

Find your future with the

CAREER CENTER

Place a job posting with us or post your resume!

http://jobs.ndna.org

Healthy Nurse, Healthy Nation

During the Holidays

Nurses Educational Funds, Inc. –

Two Goals

Nursing Burnout

THE OFFICIAL PUBLICATION OF THE NORTH DAKOTA NURSES ASSOCIATIONSent to all North Dakota Nurses courtesy of the North Dakota Nurses Association (NDNA). Receiving this newsletter

does not mean that you are a member of NDNA. To join please go to www.ndna.org and click on “Join.” Quarterly publication direct mailed to approximately 16,000 RNs and LPNs in North Dakota

The North Dakota Nurse November, December 2017, January 2018

The North Dakota Nurse Official Publication of:

North Dakota Nurses Association

General Contact Information:701-335-6376 (NDRN)

[email protected]

OfficersPresident: Vice President–Tessa Johnson, MSN, RN Membership [email protected] Amanda Abrams, BSN, RN [email protected]

Vice President– Vice President–Communications Government Relations Kayla Kaizer, BSN, RN Kristin [email protected] [email protected]

Vice President– Vice President–Finance Practice, Education,Donelle Richmond Administration, Researchdonelle.richmond@ Sherry Burg, MBA, RNgmail.com [email protected]

Director at Large-New GraduateOpen Position

Published quarterly: February, May, August and November for the North Dakota Nurses Association, a constituent member of the American Nurses Association, 1515 Burnt Boat Dr. Suite C #325, Bismarck, ND 58503. Copy due four weeks prior to month of publication. For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, [email protected]. NDNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.

Acceptance of advertising does not imply endorsement or approval by the North Dakota Nurses Association of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. NDNA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of NDNA or those of the national or local associations.

Writing for Publication in The North Dakota Nurse

The North Dakota Nurse accepts manuscripts for publication on a variety of topics related to nursing. Manuscripts should be double spaced and submitted electronically in MS Word to [email protected]. Please write North Dakota Nurse article in the address line. Articles are peer reviewed and edited by the RN volunteers at NDNA. Deadlines for submission of material for 2017 North Dakota Nurse are 3/13/17, 6/13/17, 9/13/17 and 12/13/17.

Nurses are strongly encouraged to contribute to the profession by publishing evidence based articles. If you have an idea, but don’t know how or where to start, contact one of the NDNA Board Members.

The North Dakota Nurse is one communication vehicle for nurses in North Dakota.

Raise your voice.

The Vision and Mission of the North Dakota Nurses Association

Vision: North Dakota Nurses Association, a professional organization for Nurses, is the voice of Nursing in North Dakota.

Mission: The Mission of the North Dakota Nurses Association is to promote the professional development of nurses and enhance health care for all through practice, education, research and development of public policy.

How to submit an article for The North Dakota Nurse!The North Dakota Nurses Association accepts articles on topics related to nursing. We also accept student articles

& evidence based practice articles. All articles are peer reviewed and edited by

NDNA volunteers.

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THE OFFICIAL PUBLICATION OF THE NORTH DAKOTA NURSES ASSOCIATIONSent to all North Dakota Nurses courtesy of the North Dakota Nurses Association (NDNA). Receiving this newsletter

does not mean that you are a member of NDNA. To join please go to www.ndna.org and click on “Join.” Quarterly publication direct mailed to approximately 16,000 RNs and LPNs in North Dakota

Vol. 86 • Number 3

August, September, October 2017

The North Dakota Nurse

N O R T H D A K O T A N U R S E S A S S O C I A T I O N

Seeya, Summer.

President’s Message

Tessa Johnson

Tessa Johnson, MSN, BSN, RNGreeting Nurses of North Dakota! It is hard to

believe that it is August and summer is already coming to a quick close. This is the time we get to welcome back short days, crisp air, colorful leaves, and back to school. One of the joys of living in ND is we have the pleasure of feeling the seasons change, but do we actually take the time to enjoy it? The great thing about a season change is that we can look at it as a fresh start to our health goals. As you all know ANA has officially challenged nurses across the country in 2017 to the Healthy Nurse, Healthy Nation Campaign. Moving into the fall season there are many things we as nurses can do in our lives to meet our health goals; I would like to share a few ideas.

Sign off/Disconnect: Sign out of social media, turn your phone off and enjoy the surroundings. Go for a walk and spend time with your kids, loved ones and animals. Enjoy the colorful trees and crunching leaves under your feet. Taking a walk in the fresh air is sure to increase your Vitamin D levels, make you happier and improve your concentration and mood (McMullen, 2013). Get activity: For those of us that are parents, we spend a lot of time taking our kids to sports and activities; think about joining a team for you! Think about fall sports such as flag football, soccer, volleyball, hiking, yoga and many other options. Also, don’t forget the things we do every day that get our feet moving. According to McMullen (2013), “For a 150-pound person, 30 minutes of raking leaves, 30 minutes of planting and weeding and 30 minutes of playing with the little ones each burns roughly 150 calories.”

Autumn Veggies: Another benefit of the fall season is the vegetables that are readily available; take advantage of this! Remember, if we eat a plant-rich diet, we automatically decrease the risk for diabetes, hypertension, and heart disease. This time of year who doesn’t LOVE pumpkins? Did you know that the pulp of the pumpkin is rich in Vitamin A and C? Instead of throwing it out, look for a good recipe to bake with your family and savor the flavors.

Get Crafty: We are nurses and we can do anything, right? Why not use our favorite fruits and get crafty with the kids. If you have an abundance of apples – try this idea! Cut apples in half from top to bottom, dry the cut surface with a paper towel and remove the seeds. When the cut surface is dry, cover it with the paint color or ink pad of your choice. Make sure the entire surface is covered, and then stamp the apple on any surface you want – cardstock for stationery, paper for a household masterpiece, brown lunch bags, book covers or even cloth bags. Once it’s dry,

use paint or markers to add a stem and a leaf. Use the cards for invitations to a fall party or spruce up a plain cloth bag with apple designs for a unique back-to-school book bag (Glassman, 2013).

I have touched on ways to satisfy our stomachs, our minds, our souls and our feet! This time of the year is busy; No. 2 pencils are everywhere, shoes and backpacks are piling up like Mount Everest. We are balancing multiple sports schedules and your family and your work has you pulling your hair out. Try to remain focused and take time for you, your family and what makes YOU happy. We all have to find a balance in our life to be a healthy nurse. Be well, we need all of you!To learn more about a healthy nurse lifestyle join us for NDNA’s “Healthy Nurse Conference” in Bismarck on October 6th! Register at ndna.org by Sept 15th for early bird pricing!ReferencesGlassman, K. (2013). Fall Family favorites: Apple Picking

and More. US New and World report, 2. Retrieved from http://health.usnews.com/health-news/blogs/eat-run/2013/09/09/fall-family-favorites-apple-picking-and-more

McMullen, L. (2013). 10 Tips for a Healthy Fall. US New and World report, 2. Retrieved from http://health.usnews.com/health-news/health-wellness/slideshows/10-tips-for-a-healthy-fall?slide=12

MEMBERSSAVE THE DATE

For the MEMBERS ANNUAL MEETINGOctober 7th, 2017

Ramada Inn, Bismarck after the Healthy Nurse Conference on October 6th!Registration links on our Facebook page and website at www.ndna.org

Highlights from ANA Hill Day and Membership

Assembly

In Memory of former Executive Director of

NDNA, Betty Maher

Nurses Book for Sale:

North Dakota Nurses Over

There

Deadline for submission for the rest of this year is 12/13/2017. Send your submissions to [email protected].

Welcome New Members

Linda HaiderKristine MartinAustin AndersonEvelyn TelfordTessie DomingoJennifer Vandal

Nicole ScherrFeyissa WagessoJosefina VasquezParmalee BakerAmy ZabinskiSherri Miller

Trisha HoffartMichelle Mjelstad Maier

Ciara SchmidtLaken KittelsonShila Thorson

Liza YstaasChristine Knudsvig

Susan IndvikKylie Mindt

Kezia KvernumKaitlyn Awender

Dakota College at Bottineau (DCB) is seeking an instructor to teach courses in its nursing program to undergraduate students in practical

nursing and associate degree nursing programs.

Master of Science in Nursing, Nursing Education, or related area required, or currently enrolled in a master’s degree program with an education plan approved by the CNE

which will allow completion of the master’s degree program within three years.

Competitive salary based on education and experience, comprehensive fringe benefit package including TIAA-CREF retirement plan and full coverage for family health insurance.

APPLICATION INSTRUCTIONS: Send a letter of application, http://www.dakotacollege.edu/faculty-and-staff/employment/, college

transcripts and the information for three professional references to: HR Manager, Dakota College at Bottineau, 105 Simrall Blvd, Bottineau, ND 58318 or email to:

[email protected] (Note: Incomplete files will NOT be considered.)Dakota College at Bottineau is an Equal Opportunity/Affirmative Action employer.

Associate Degree Nurse Faculty/Clinical Instructor, Fulltime

Dakota College at BottineauTrinity 5th Avenue Medical Building, Minot, ND

mailto:jmyers%40nd.gov?subject=

http://annecarlsen.org/careers

November, December 2017, January 2018 The North Dakota Nurse

Kayla Kaizer, BSN, RN

Featuring DeeAnna Opstedahl MSN, RN, CNOR

“The achievements of an organization are the results of the combined effort of each individual.” – Vince Lombardi.

DeeAnna Opstedahl is the Vice President of Patient Care Services at CHI St. Alexius Health in Dickinson and has recently been elected as the VP of Finance for the 2018-2020 Board of Directors.

Please tell us about your nursing career? I graduated from South Dakota State

University with my BSN in 1990. I then worked in many different areas in several of the hospitals in the Black Hills. In 1998, I began to be interested in leadership. I started as the ICU director and soon became the Acute Care Director in Spearfish, SD. When my children were of the age and they needed me home more, I started working in one of the areas I hadn’t had an opportunity to experience yet, the OR. I fell in love with the OR. I loved circulating and I loved to scrub in. I then made the move to Sturgis, SD and did everything

Member Spotlight

DeeAnna Opstedahl

from Charge Nurse to Director of the OR. It gave me the fantastic opportunity to work on my trauma skills at least 3 weeks of the year. I was then recruited to Dickinson to be the Director of Surgical Services. During this time, I completed my MSN in leadership. I graduated with a 4.0 and joined Sigma Theta Tau. After 3 years, I became the VP of Patient Care Services. My main goal in taking this position was to improve patient care and staff satisfaction. I wanted to base care on evidence whenever possible. I wanted staff to know how much they were appreciated. I am so glad I took this opportunity and hope others are too.

What made you want to become a nurse? To be honest, I started out thinking I was going

to become an electrical engineer. Scholarships soon ran out and my advisor suggested nursing, since I had worked as a CNA to help pay for school. I loved the idea of being able to help people when they needed it most and that I could make a difference in their experience.

What benefit has it been to you to belong to NDNA?

NDNA has provided me an opportunity to have a voice. Along with NDHA, it has provided several opportunities to learn and grow. I enjoy the opportunity to discuss legislation issues as well as local concerns. It has also provided the opportunity to meet and work with several other nurses in the state of ND.

Why do you think it is important to get involved in a professional organization?

The professional organizations (specifically nursing) gives nurses a voice regarding issues that affect them and their practice. It is a way to come together to support each other and learn from each other.

What guidance would you give to a new nurse joining the profession?

I would highly recommend it. You will meet others with similar passions and you can keep in touch with what it is you’re interested in.

What do you think sets you apart from other nurses?

I am not sure that I am set apart from other nurses. We have a passion for what we do or we wouldn’t be doing it. I feel like it is more than a career for me. It is a way of life. I am not sure what I would do if I wasn’t a nurse anymore.

What do you consider the most frustrating thing about the nursing profession today?

Nursing has a lot of research to back its theories. Most of what is done today is evidence based practice. I feel some patients don’t give nurses enough credit.

What do you like to do in your free time?I love to camp, hike, fish, and do any water

sports.

What goals do you still have for yourself (Professionally or personally)?

I would like to become more involved with the legislation and help to make a difference.

Is there anything else you want to tell us about you?

I am now teaching a class at DSU and will hopefully encourage the future nurses I speak to, to become active in their career and realize what a difference they can make, not only for their patients but for their profession.

Conference title:

Back to the Basics: What Florence Couldn’t Predict!

Conference date:

Friday, April 13

Location:

Grand International HotelMinot, ND

New Grads Welcome!

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Ask our Director of Nursing about our Nurse Tuition Reimbursement Opportunities!

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Healthy Nurse, HealthyKayla Kaizer, BSN, RN

With the holidays fast approaching, some of us can already feel our belts

getting looser and our clothes getting tighter. As part of our Healthy Nurse, Healthy Nation

initiative, we thought it would be a good idea to include some recipes for healthy side dishes and

appetizers to make during the holidays.

RecipeHeaping ½ cup raw cashews, soaked for 30 minutes or overnight

½ cup unsweetened almond milk (or water)

3 medium onions, divided

3 tbsp whole grain bread crumbs (sub gluten-free bread crumbs for gluten-free)

3 tbsp flour (can substitute gluten-free oat flour)

2¼ tsp salt (divided)

2 lbs frozen cut green beans

1 tbsp extra virgin olive oil

1 medium onion, diced

3 cloves garlic, minced

2-8oz packages sliced mushrooms, chopped

Pinch ground nutmeg (optional)

1 tbsp soy sauce (sub tamari for gluten-free)

¼ cup dry white wine

Freshly ground black pepper, to taste

Place cashews in a bowl and cover with hot water. Set aside to soak for 30 minutes or overnight. (If you have a nutribullet or high speed blender, 10 minutes of soaking is fine.)

Meanwhile, preheat oven to 475F.

Thinly slice two of the onions, setting aside the other onion for later. Combined sliced onions with bread crumbs, flour and ¾ tsp salt in a large bowl, tossing to combine. Be sure to separate each individual onion piece. Spread onions in an even layer on a baking sheet sprayed with cooking spray or lined with a Silipat. Spray once again with cooking spray. Bake for 20-25 minutes, tossing halfway through. Watch carefully to make sure they don’t burn towards the end of cooking. Once onions are done, remove from oven and lower oven heat to 350F for casserole.

Bring a large pot with two inches of water to a boil. Once boiling add green beans. Bring back to a boil (this may take a while) and cook over medium heat for about 5 minutes, or until tender. Drain and run cold water over green beans to stop cooking. Set aside.

In a large skillet, heat olive oil over medium heat. Chop remaining onion. Once hot, ad to pan and cook for about five minutes before adding garlic and mushrooms. Cook for another ten minutes, stirring often. Add nutmeg, soy sauce, white wine, 1½ tsp salt, and pepper. (It will taste salty, that’s ok!). Simmer for about five minutes.

Blend soaked cashews with almond milk in a blender or food processor until completely smooth and creamy. Set aside.

Stir in cashew cream and ¼ of the baked onions. Stir in cooked green beans.

Spread mixture into a large casserole dish. Top with remaining baked onions. Bake at 350F for 20 minutes (if onions are on the crispier side, you can cover with foil for first half of cooking.) Serve hot!To make this dish ahead of time, make the sauce and the green beans then store in separate containers in the fridge. The next day, bake the onions and combine everything per the recipe.

Pomegranate and Cranberry Relish

1 pound fresh (or frozen) cranberries,

washed

1 cup sugar

1 serrano pepper (more if you like spicy,

less if not)

½ cup roughly chopped fresh basil leaves

¾ – 1 cup pomegranate arils or seeds

(reserve a few for garnish)

Finely chopped fresh basil, for garnish

Place the cranberries, sugar, and serrano peppers in a food processor.

Pulse on and off several times until cranberries are coarsely chopped.

Don’t over-process. Add basil and pulse a few more times. Not too

much, you want basil bits to be visible in relish. Transfer to a storage

container and add pomegranate arils. Refrigerate for at least 2 hours

or till ready to use.

For the crostini, preheat oven to 350˚F. Place baguette slices on prepared

pans. Brush lightly with oil. Sprinkle lightly with salt and a grind

of pepper (don’t leave this step out!) Bake for 14-18 minutes or until

golden, rotating pans halfway through baking time.

To assemble bruschetta, whisk cream cheese until creamy. Spread

about ½-1 tablespoon on each crostini. Top with a scoop of the relish.

Garnish with basil. Enjoy!

RecipeCrostini

1 thin, good quality

baguette, sliced about

¼ inch thick

½ cup extra virgin olive

oil

Sea salt

Freshly ground black

pepper

8 ounces low-fat cream

cheese, softened

Preheat oven to 350 degrees Fahrenheit and prepare a casserole dish. Set aside. In a 4 QT pot of boiling water, boil the sweet potato for 20 minutes until fork soft. When the sweet potato is finished boiling, drain and mash. Add the rest of the ingredients and using the potato masher, mix all the ingredients together until they are incorporated, about 2 minutes of mashing. Spoon sweet potato mix into the casserole dish and top with the Maple Pecan topping. Bake for 30 minutes (check that nuts don’t burn - if they are browning too quickly cover with foil) then remove from oven. Allow to cool for 10 minutes and then serve.

Maple Pecan Topping3 tablespoon maple syrup

6 tablespoons almond flour

1½ tablespoon melted vegan butter

3/4 cup pecans, coarsely chopped

While sweet potato is boiling or right before, mix all the ingredients for the maple pecan topping together and set aside until needed.

RecipeSweet Potato Casserole

3.3 pounds sweet potato, peeled and cut into 1 inch cubes

3 tablespoons brown sugar

3 tablespoons maple syrup

1/4 cup unsweetened almond milk 6 tablespoons coconut oil or olive oil 6 tablespoons vegan butter, room temperature

1 teaspoon cinnamon

1/2 teaspoon saltSitting Bull College – NOW HIRINGSitting Bull College – NOW HIRING

Please submit: Cover letter, resume, official transcripts, 3 current reference letters signed and dated (1 from immediate supervisor), certificate of Indian blood (if

applicable), copy of Social Security Card & Valid driver’s license & SBC Background check to: Personnel Office Sitting Bull College 9299 HWY 24 Fort Yates, ND 58538

(701) 854-8004 w http://online.sittingbull.edu/ICS/Jobs/New hires are subject to Federal, State, Tribal background checks and pre-employment drug/alcohol testing. AA • EEO • M • F • B Employer Any applicant not having the above documents enclosed will not be considered.

w Director, Division of Nursingw Clinical Nursing Instructor (Part-time)w Clinical Nursing Laboratory Technician (Part-time)

Hiring RNs & LPNs$5,000 SIGN ON

BONUS POSSIBLEWe hire new graduates and offer tuition reimbursement

For more information,

call 701-845-8222 or visit our website at

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Applications can also be picked up at

979 Central Ave N, Valley City ND 58072

and faxed back to 701-845-8249.

Visit our new Facebook page @ www.facebook.com/sheyennecarecenter


Nation During the HolidaysCombine oat flour, brown sugar, and pumpkin pie spice in a mixing bowl. In a small sauce pan over medium heat, combine almond butter and maple syrup. Heat until smooth. Remove from heat and stir in vanilla. Add the almond butter mixture to the dry ingredients along with the pumpkin puree. Stir until combined. Roll into 1-1 ½ inch balls and place on cookie sheet. Combine additional cinnamon and sugar in a bowl and roll each ball into the mixture. Enjoy!

Recipe2 cups Gluten Free Rolled Oats, ground to a fine powder (or 1 ¾ cups oat flour)

¼ cup Coconut Flour2 tbsp. Brown Sugar1 tbsp. Pumpkin Pie Spice½ cup Pumpkin Puree1 tsp Vanilla Extract¼ cup Almond Butter¼ cup Maple SyrupCinnamon and Sugar for rolling

Fill a large saucepan with about an inch of water, and insert a steamer

basket. Bring the water to a boil, and add the cauliflower florets. Reduce

the heat to a simmer and cover, allowing the cauliflower to steam for 6-8

minutes, or until fork tender.

Drain the steamed cauliflower, and transfer to the bowl of a large food processor.

Add in the roasted garlic cloves and seasonings, and process to your desired

texture. Feel free to add a splash of almond milk or water, if needed. I ended up

using about a teaspoon of fine sea salt for this particular batch, but each batch

may vary, so be sure to start with less than

you think you need, and add more as you

go. Serve warm and enjoy!

RecipeMedium-sized head of

cauliflower, chopped into

florets (about 1 1/2 lbs.)

3 roasted garlic cloves

1 tsp fresh thyme leaves

1 tsp fresh chives, chopped

salt and pepper, to taste

1 cup Chickpeas, skins removed2/3 cup Pumpkin, Canned1/4 cup Maple syrup, Pure1 Maple syrup, Pure1 tbsp. margarine4 tsp Pumpkin spice1/8 tsp Salt

2 tbsp. Sugar

2 tsp Oil

1 Pita bread, wedges

Combine sugar and pumpkin pie spice. Cut pita into wedges and brush with melted vegan margarine. Sprinkle with the sugar mixture. Place onto a cookie sheet into a preheated oven set at 350 degrees until golden. Meanwhile, place all of the hummus ingredients into a food processor and blend until smooth. Place the hummus into a serving bowl and drizzle with pure maple syrup and a sprinkle of the pumpkin pie spice. Arrange the toasted cinnamon-sugared pita chips around the hummus and serve immediately.

Recipe

In a large skillet over medium heat, melt butter. Add onion, carrot, and celery and sauté until soft, 7 to 8 minutes. Add cauliflower and mushrooms and season with salt and pepper. Cook until tender, 8 to 10 minutes more. Add parsley, rosemary, and sage and stir until combined, then pour over vegetable broth and cover with a lid. Cover until totally tender and liquid is absorbed, 15 minutes. Serve.

Recipe Cauliflower Stuffing4 tbsp. butter

1 onion, chopped2 large carrots, peeled and chopped2 celery stalks, chopped or thinly sliced1 small head cauliflower, chopped1 c. chopped mushroomsKosher salt

Freshly ground black pepper1/4 c. chopped fresh parsley2 tbsp. chopped fresh rosemary1 tbsp. chopped fresh sage (or 1 tsp. ground sage)

1/2 c. vegetable or chicken broth

“Be patient with yourself as you evolve. Small, healthy choices make a big

difference in the long run!” – Author unknown.

A new psychiatric hospital has opened in Grand Forks, ND.

A compassionate hand in a time of crisis, Red River Behavioral Health is dedicated to giving hope and

creating change.

Our nursing department is looking for

REGISTERED NURSESto join our team.• Competitive wages & benefits• $5,000 sign on bonus• Flexible Schedules• Relocation assistance when needed

Please apply online at redriverbhs.com or contact Jenny with any questions at 701-765-7247.

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PMHNP: A Choice Beyond PassionThe authors are graduate students from the

University of North Dakota, PMHNP program: Alicja Cebulak, RN-BSN; Andrea Petersen, RN-BSN;

Lance Briggs, RN-BSN; Rebecca Gonzalez, RN-BSN; RN-BSN, Elizabeth McDevitt, RN-BSN;

Katie West, RN-BSN.

According to the National Alliance on Mental Illness (2017) forty-four million people in the United States experience a mental illness, roughly ten million adults suffer from a severe mental illness, and approximately 60% of adult population with mental health problems do not receive any care. In 2016, it was estimated that twenty percent of children had a serious mental illness and only half of them received treatment for their condition. The workforce opportunities and general future of Psychiatric and Mental Health Nurse Practitioners (PMHNP) remains quite broad when contrasted against the growing need

for psychiatric healthcare providers. The Health Resources and Services Administration (HRSA, 2015) reports that in 2013 there was an estimated deficit of 2,800 psychiatrists, which is anticipated to increase to a need of 6,090 by 2025. The deficit of psychiatric providers is not a new revelation, and the PMHNP workforce is poised perfectly to help relieve the psychiatric provider deficit in the immediate future.

Psychiatric mental health nursing began at the end of the 19th century when reform movement occurred with the focus of mental health care changed from restrictive and custodial care to social and medical treatment for mentally ill individuals. In 1954, Hildegard Peplau established the first clinical nurse specialist (CNS) graduate program in psychiatric nursing at Rutgers University (Lego, 1996). This establishment was an answer to the passage of the National Mental Health Act of 1946 and creation of the National Institute of Mental Health in 1949. Furthermore, the American Nursing Association in 1973 published the Standards of Psychiatric Mental Health and began certifying nurse generalists in psychiatric–mental health nursing (Boling, 2003). In the 1990’s, psychiatric mental health practitioner (PMHNP) programs started to grow as a response to changes within the nursing profession and demands to meet the shortage of mental health providers. Today, PMHNPs are educated on masters’ or doctoral level and they are required to pass a national board exam of competency offered by the American Nurses Credentialing Center (ANCC) (Wheeler & Haber, 2004).

Currently, there are 1,397 Advanced Practice Registered Nurse (APRN) licenses in the state of North Dakota of which just 30 are PMHNPs (North Dakota Board of Nursing, 2017). PMHNPs may work in a variety of settings including inpatient and outpatient practices (Wheeler & Haber, 2004). The role is diverse and PMHNPs function as consultants or like psychiatrists by completing assessments, diagnosing, and prescribing psychotropics to manage acute and chronic mental illnesses. PMHNPs integrate knowledge of medical and psychiatric disorders to have complete differential diagnosis and to treat or refer as appropriate.

There are many benefits of having PMHNPs including decreasing disparities and increasing access in rural areas. Diverse groups and rural America are especially impacted with the lack of access to mental health services (Safran et al., 2009). Disparities exist in behavioral health services in people with disabilities, youth, LGBTQ, and different racial populations (SAMHSA, 2014). This demands a call for action and PMHNPs can help decrease the burden of lack of access to care by increasing the bulk of providers that work with persons with mental illness. They play an essential role in collaborating and researching innovative ways to eliminate disparities in access to mental health care.

Although there are many similarities among health care professions, an important question to ask is how PMHNPs differ from FNPs (Family Nurse Practitioners), PAs (Physician Assistants) and psychiatrists. PMHNPs can perform comprehensive physical and mental health assessments (Wheeler & Haber, 2004). Both the PMHNP and the FNP are educationally prepared to assess for mental health disorders. The difference exist in the extensiveness and complexity of the assessment of the disorder and treatment (Parish & Staten, 2017). PAs work under the supervision of physicians while PMHNPs work independently in 21 states and have prescriptive authorities in 50 states (CareerBuilder, 2016). PMHNPs receive comprehensive education in mental health with emphasis on a holistic, biosocial, patient-centered model of care while PAs follow a disease-centered model of care and their education is more general rather than specific to mental health. Similar to Adult Geriatric Nurse Practitioners and FNPs, PAs are not certified to provide psychotherapy to their clients. On the other hand, PMHNPs and psychiatrists can provide psychotherapy to individuals, groups, and families. A psychiatrist is a physician who completed a 3-4 year residency in psychiatry following medical school. Psychiatrists and PMHNPs can perform physical and psychiatric

assessments, order and interpret tests, provide psychotherapy, prescribe medications and order commitment to an institution. State laws do vary regarding PMHNPs’ ability to order a commitment to an institution and the types of medications they can prescribe (Zakhari, 2016).

Overall a PMHNP is a great profession that helps to protect, promote, and restore health of those with mental illness (Muxworthy & Bowllan, 2011). There is no predicted shortage of jobs for PMHNP as the estimated shortage of psychiatrists continues to grow (HRSA, 2015). To enhance the profession, there is a need for collaboration to formulate strategies to remove unnecessary restrictions on PMHNP practice. More research comparing competencies, safety and consumer satisfaction between PMHNPs and psychiatrists to define our specialty would benefit the profession. This nurse practitioner specialty needs people such as yourself who are passionate, hardworking, see challenges as opportunities, and knowledge as a tool to make changes in the lives of individuals with mental illnesses across the lifespan. PMHNPs are the future of affordable healthcare and hope for recovery in mental health care. Therefore, if working with diverse populations and being innovative is of any interest to you, seriously consider taking the next steps to become a PMHNP.

ReferencesCareerBuilder (2016). Three key differences between

a nurse practitioner and physician assistant. Retrieved from http://www.careerbuilder.com/advice/3-key-differences-between-a-nurse-practitioner-and-a-physician-assistant

Boiling, A. (2003). The professionalization of psychiatric nursing: From doctors’ handmaidens to empower professionals. Journal of Psychosocial Nursing, 41(10). Retrieved from https://web-a-ebscohost-com.ezproxy.undmedlibrary.org/ehost/pdfviewer/pdfviewer?vid=1&sid=03838c85-7014-4768-959b-6547e4b97181%40sessionmgr4007

Health Resources and Services Administration/National Center for Health Workforce Analysis; Substance Abuse and Mental Health Services Administration/Office of Policy, Planning, and Innovation. 2015. National Projections of Supply and Demand for Behavioral Health Practitioners: 2013-2025. Rockville, Maryland.

Lego, S. (1996). Long live the CNS and the NP in psychiatric nursing: Do not blend the roles. The Online Journal of Issues in Nursing. Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume/No1June96/CNSNPinPsychNursing.html

Muxworthy, H., & Bowllan, N. (2011). Barriers to practice and impact on care: An analysis of the psychiatric mental health nurse practitioner role. Journal of the New York State Nurses Association, 42(1), 8-14. Retrieved from http://ezproxy.undmedlibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,url,uid,cookie&db=c8h&AN=108177489&site=ehost-live

National Alliance on Mental Illness (2016). Mental health facts. Retrieved from https://www.nami.org/Learn-More/Fact-Sheet-Library

North Dakota Board of Nursing. (2017). Current statistics. Retrieved from https://www.ndbon.org/

Parrish, E. & Staten, R. (2017). Scope of practice: the similarities and differences of family nurse practitioner and psychiatric mental health nurse practitioner practice. KBN Connection, 51, 24-25. Retrieved from http://epubs.democratprinting.com/publication/?i=411466&article_id=2794182&view=articleBrowser&ver=html5#{“issue_id”:411466,”page”:24}

Wheeler, K. & Haber, J. (2004). Development of psychiatric-mental health nurse practitioner competencies: opportunities for the 21st century. Journal of the American Psychiatric Nurses Association, 10(3), 129-138. Doi 10.1177/1078390304266218

Safran, M. A., Jr, M. R., Huang, L. N., McCuan, R., Pham, P. K., Fisher, S. K.,...Trachtenberg, A. (2009). Mental health disparities. American Journal of Public Health, 99(11), 1962-1966. doi:10.2105/AJPH.2009.167346

SAMHSA. (2014). Health disparities. Retrieved from https://www.samhsa.gov/health-disparities

Zakhari, R. (2016). What are the differences between psychiatrist, psychologists, psychiatric nurse practitioners, and psychotherapists? The Informed Patient. Retrieved from https://metromedicaldirect.wordpress.com/2014/06/25/what-are-the-differences-between-psychiatrists-psychologists-psychiatric-nurse-practitioners-and-psychotherapists/

You are invited to the Healthy Nurse Healthy Nation

Conference in Grand Forks!

SAVE THE DATEMarch 28th, 2018

Choice Fitness, Grand Forks

Take time for YOU!Presented by

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Nursing BurnoutMaddie Frederick, Ashly Headrick,

Kayla Kaizer, Molly SepiolUniversity of Mary

Nurse turnover and nursing burnout has been a never-ending problem. However, the amount of turnover related to burnout has increased in recent years and nurses are exposed to higher risks associated with burnout than any other occupation (Nurse Burnout, 2013). Patients today are much sicker and are suffering from multiple comorbidities rather than one disease. Caring for patients with multiple diagnoses can increase the workload of the nurse leading to an increase in stress level. Increase patient load and stress can lead to nurse burnout and in turn, nurse turnover. Hospitals and nursing units must be educated on how to prevent these high levels of stress.

“Burnout can be defined as a bio-psychosocial response to chronic emotional stress” (Hertel, 2009). Quality of care is negatively affected when the nurse becomes detached from their patient care and work environment. Responsibilities outside of work, lack of sleep, improper nutrition, heavy workload and inadequate breaks can lead to a cynical perception towards nursing (Homer, Dawson, Duffield, Roche, and Stasa, 2014). Depersonalization occurs when the nurse develops a negative attitude or perception about their job. Often, the adverse outlook can affect the relationship they have with their patient. Depersonalization can present itself through isolation behaviors, insensitivity, dehumanization, negativity, withdrawal from patients, and loss of satisfaction in work (Beamud et al., 2013).

Hertel (2009) found that there are three levels of burnout. Level one presents itself with mild signs and symptoms that are usually short in duration. These symptoms of burnout usually come and go. If there are no interventions to alleviate stressors in level one, it can lead to level two. This is where the symptoms are more noticeable and last longer. In this stage, the signs and symptoms are much more difficult to overcome. Level three is reached when signs and symptoms become regular and occur on a routine basis. In this level, stress becomes more chronic. Work stress is a major issue because it interferes with the nurse’s ability to effectively care for their patients.

The study organized by Leiter and Maslech (2009) found that dissatisfaction is a major contributor to nurses considering leaving the nursing career. This has led to a nursing shortage due to high turnover rates. While Chen, J., Davis L., Davis, K., Pan,W., and Daraiseh, N. (2011), found that an acceptable workload is defined as “a level that an individual is able to sustain for a given shift in a physiologically steady state without fatigue or discomfort.” It is above this accepted level that a person’s work performance and well-being is negatively affected. Levels above the accepted workload increase stress and lead to nursing burnout.

Fearon (2011) found four main areas that were identified were problem-focused and emotion-focused coping, self-awareness and emotional intelligence, lifestyle and coping styles, and clinical supervision. Self-awareness and emotional intelligence is a key step to being able to emotionally cope with burnout. Lifestyle and coping styles is the ability to lead a healthy life through diet, exercise, and relaxation.

Throughout the review of literature, the themes remain the same. High stress levels and increased patient loads while working short staffed leads to high burnout rates which in turn lead to high turnover and poor patient care. Education and effective coping mechanisms must be addressed in order to prevent nursing burnout and high turnover rates.

Education would be provided for nurses currently employed and would be incorporated into orientation for new nurses. Part of education offered would target three main components: prevention of emotional exhaustion, depersonalization and a diminished sense of personal accomplishment. A variety of strategies will be offered for the nursing staff and different coping mechanisms will be identified to decrease stress. Education will also be offered to learn how to identify signs of burnout before it occurs. Setting goals will be an area of focus for staff

and offering a variety of coping strategies and education related to burnout will ensure the nursing staff has the information they need to prevent nurse turnover.

The use of coping mechanisms can have many advantages related to nursing burnout in hospitals. As a nurse, it is important to act as a patient advocate. Preventing burnout will allow the nurse to be a healthy, reliable voice for the patient and will be able to provide them with the proper care. Advantages of proper education can lead to the prevention of emotional exhaustion, depersonalization and a diminished sense of personal accomplishment.

Emotional exhaustion is displayed by 43.75% of nurses and can vary from person to person depending on the situation. Emotional exhaustion is related to the high demands of a job for an extended period of time, which in return produces a large amount of continuous stress. Depersonalization accounts for 37.5% of nurses and occurs when a nurse creates a negative viewpoint or of their job. Depersonalization is noticed when the nurse becomes extremely withdrawn from their job; they become isolated from their patients and no longer feel satisfaction. Low levels of personal satisfaction or accomplishment were displayed by 66.6% of the nurses. With low levels of personal accomplishment, nurses become unsatisfied with the work they are doing and have the potential to lead to other more serious behaviors as well. Ultimately, low levels of personal accomplishment can drive a nurse to quitting her career all together (Dantas de Oliveria Souza, N., Dopico da Silva, L., Kestenberg, C., Tavares, K., 2014).

Education related to the prevention of nurse burnout has a plethora of advantages. If emotional exhaustion, depersonalization and low levels of personal accomplishment are prevented, the potential of a better working environment is increased. It is also important to use appropriate coping mechanisms in order to help manage stress levels. Some other strategies that could be used in order to help prevent burnout would include: acknowledgement of the work done by others, encourage each other at work, take stress breaks, set goals, learning to say no to higher demands, managing anxiety, finding appropriate ways to take care of their body related to high demands of work, and providing a safe and appropriate working environment.

In a study conducted by Law and Taormina (2000), another method that can be used in order to reduce stress is by evaluating the environment the nurses are required to work in. This would be considered an organizational socialization. The four areas that are part of organizational socialization are training, understanding of ones’ job, coworker support, and prospects for a rewarding future in ones’ company.

Training is important when it comes to reduction in the amount of stress amongst nurses. If a nurse is appropriately trained then the employees can be expected to perform well on the job. Appropriate training can help enhance the nurses self confidence in certain skills. This will then help lead to a greater competence and in return help reduce overload and burnout.

The next method that should be used in order to help prevent nursing burnout understands of ones’ own job and company goals. Understanding of the way that their organization runs can be correlated through the nursing supervisors or administration. If nurses understand their role, then this will allow them to be able to adjust easier to their job and apply information. Understanding the job roles also allows the nurse to be much more confident in their approach to care, which in turn increases self- assurance and confidence.

Another area of organizational socialization is future prospects. This is referring to certain rewards and opportunities that the facility can supply to their employees. Offering a reward helps serve as reinforcement for the nurses. Some rewards that can be used are offering bonuses, promotions, and awards showing recognition. Rewards help workers have satisfaction in their job and encourages them and helps them create a positive outlook on the future of their career.

Coworker support is one of the most important

methods that can be used in order to help prevent emotional exhaustion, depersonalization, and low levels of personal accomplishment. Coworker support is the main component to help alleviate stress. If support is given amongst the nurses, this will increase their self-esteem. Support from others encourages nurses to feel a part of a community, which in turn will motivate them and help prevent the nurse from burnout.

Implementing an education service to prevent burnout has a multitude of advantages. However, there are possible disadvantages related to the education. A potential disadvantage would be the cost to have appropriate staffing. Providing more staff can help prevent nursing burnout, but unfortunately the hospital would be required to spend more money in order to train and employ the extra nurses. Another disadvantage would be that there is no way to monitor if the staff is applying their education outside of work. Are they taking the proper steps in order to prevent burnout? There is no effective or easy way to monitor this. Setting goals within a hospital can be a great tool to use in order to motivate the nurses. However, if the goal is not met, this could regress to the feeling of low personal accomplishment and a decreased self-esteem.

Steps for implementing education on nursing burnout include: gaining knowledge about nursing burnout, persuading others about the importance of preventing nurse burnout, deciding to adopt or reject the purposed education plans, actually implementing the education and in-services about preventing nurse burnout, and finally evaluating if the education was effective or not and continuing to provide education or stop (Woods, 2014). The nursing leaders must identify that nurse burnout is a problem and the need to do something to prevent it from occurring amongst their staff. Once they have developed an education plan, they need to recruit other staff members, such as unit managers and/or charge nurses, to teach the materials. Every staff member in the healthcare setting will be affected by the education on nursing burnout. Nursing is a team collaboration; if everyone is taught to recognize the signs and symptoms of nurse burnout, they can implement the proposed changes such as complementing or acknowledging the nurse for his or her efforts. A simple thank you may make a huge difference in a nurse that might be experiencing burnout. Also if other healthcare workers are acknowledging the nursing staff, they will feel as if they are making a difference and are a part of the organization as a whole.

The financial concern for implementing education on nurse burnout is low, however, hiring more staff is a huge financial concern. The healthcare facility would have to pay for the education and classes, but the costs to educate staff is much lower than the cost of recruiting, hiring, and replacing staff as well as costly medical errors caused by nurses experiencing burnout. Hiring new staff to help with the nursing shortage and burnout rates is very expensive. Hiring a new nurse will cost about $10,000 in just direct recruitment costs and replacing nurses will cost $42,000-$64,000 (Diana, 21014). If new nurses are hired and the proper education and training is implemented, the healthcare facility could save millions each year.

Resources are essential to accomplish any sort of goal, especially in preventing nurse burnout. Workshops for nurses can be a great way to implement the education for preventing burnout. The resources for this can be as simple as utilizing the human resources department in the hospital. They can take the time to prepare a workshop for nurses, which can take a few hours and be as simple as a slide show. The human resources department is available to make sure that employees are taken care of and that they are educated on many topics pertaining to nursing such as burnout. The hospital would need to pay the nurses for attending these classes or in-services, but if it can help to prevent the occurrence of burnout, it is money well spent.

Nursing Burnout continued on page 8


The human resources department can also do many things when training in new employees to help decrease the level of burnout. They have set courses for every new hire to take, and it would not take much more class to make sure that they understand their role in the hospital and what the hospital’s goals are. This can help the nurse feel as if they know what their exact role is, which can take some stress of the job away and lead to lower rates of burnout. Human resources also provide employee assistance programs such as counseling and treatment for staff. Nurses that are experiencing burnout can access this program and can be treated for burnout. Here they would learn to recognize the signs and symptoms of burnout as well as how to prevent it from occurring again.

There are many ways to prevent burnout without needing any resources other than the people that already work on the nursing units. Strategies such as these include encouraging each other and acknowledging the accomplishments and effort of others. This implementation can be as simple as having cards pre-made so that a nurse can fill it out if they have seen some extraordinary effort, and put it up on a board somewhere for everyone else to see. This can also be done by encouraging nurses to complement each other frequently. Support of coworkers can make a job a great place to work and helps to boost the morale of nurses.

Breaks are not always the top priority for nurses especially when they have a lot of things going on with their patients. Making sure that each nurse gets a couple of breaks to walk away from the floor and take a little time for themselves can help them to come back refreshed. Besides the half hour that nurses get for a lunch/dinner break, they should also get at least one, if not two fifteen minute breaks. This can be accomplished by having nurses go in shifts while other nurses watch their patients for them. This way, every nurse can have some time to themselves without worry about what is going on with their patients and what they may be missing. This could be easy to implement by having the charge nurse checking off people as they take breaks and making sure that everyone gets at least one fifteen minute break a shift.

Another resource that hospitals can utilize without needing anything extra is by giving nurses adequate training. If nurses are trained properly to do their job then they will have less anxiety about doing skills on their own. Every nurse can help to train the new employee correctly by giving them opportunities to perform skills that may not come around often, and asking if they have gotten a chance to do certain skills. This can lead to fewer mistakes made by the nurse which, in turn, can actually help save the hospital money. If nurses know what they are doing and feel confident in their skills, they will be less stressed and have less of a chance of experiencing burnout.

Evaluation of the multiple proposals for education would be fairly easy along every step of the way. The evaluation can start with new hires as they are questioned by the manager before they start on the floor about how their classroom training went and if they feel that they understand what their job is and what the hospital’s goals are. They can then follow up with the new nurse every week during training to see how it is going and if they have any concerns there. They can then address any issues with their training and come up with possible solutions, which may include extending the training or orientation period. Making sure that nurses are being recognized and

supported can be evaluated by the charge nurse on every shift. They can ask people how their shifts went and if they saw anything great being done by their coworkers. The charge nurse themselves can also watch for good things going on and acknowledge people for it, and they can make sure to emphasize teamwork and recognition of others. A workshop could be implemented for every nurse, new or experienced, to recognize the symptoms of burnout and can be evaluated by making it a mandatory in-service for people to attend. If they make it mandatory and notice some people that did not come, they can have the unit manager have a one on one talk with them about the information that they missed. This way everyone is getting the information on burnout so they can help identify it in others and help to prevent it in themselves.

Lack of nursing satisfaction leads to improper care, and therefore leads to decreased patient satisfaction. Applying the recommendation to prevent emotional exhaustion, depersonalization and a diminished sense of personal accomplishment will allow the nursing unit to maintain a healthy working environment, physically and mentally. Organizational socialization would allow nursing units to advocate for each other and offer oneself for support. Properly educating the nurse on what is expected as an individual in that role, and enforcing expectations, will ensure the nurse functions at an expected level. Nursing can be a stressful profession, so it is important for nurses to educate themselves on the importance of being aware of stressors and how to handle the stress. Early education can help prevent nurses from disowning their career.

ReferencesBeamud, M., Galvez, M., Gomez, T., Martin, J., Mingote, J., & Tapias, E. (2013).

Effectiveness of an intervention for prevention and treatment of burnout in primary health care professionals. BioMed Central, 14(173).

Chen, J., Davis L., Davis, K., Pan,W., and Daraiseh, N. (2011). “Physiological and behavioural response patterns at work among hospital nurses.” Journal of Nursing Management, 19(1), 57-68.

Dantas de Oliveria Souza, N., Dopico da Silva, L., Kestenberg, C., Tavares, K., (2014). Prevalence of burnout syndrome among resident nurses. Acta Paulista de Enfermagem, 27(3), 260-265.

Diana, A. (2014). Nurse retention rate improvement secret: analytics. Information Week: Healthcare. Retrieved from http://www.informationweek.com/healthcare/analytics/nurse-retention-rate-improvement-secret-analytics/d/d-id/1234912.

Hertel, R. (2009). Burnout and the med-surg nurse. Med-Surg Matters, http://web.a.ebscohost.com/ehost/detail/detail?vid=12&sid=7126b244-d082- 4956-b2d2-4e61b19f4370%40sessionmgr4001&hid=4114&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=ccm&AN=2010309474

Leiter, M., & Maslach, C. (2009). Nurse turnover: the mediating role of burnout. Journal of Nursing Management, 17(3), 331-339. doi:10.1111/j.1365-2834.2009.01004.x

Nurse burnout: epidemic, or mendable malady? (2013). Nursing Licensure.org. Retrieved from http://www.nursinglicensure.org/articles/nurse-burnout.html

Prevalence of burnout syndrome among resident nurses. Acta Paulista de Enfermagem, 27(3), 260-265.

Taormina, Law, & Taormina. (2000). Approaches to preventing burnout: the effects of personal stress management and organizational socialization. Journal of Nursing Management, 8(2), 89-99. doi:10.1046/j.1365-2834.2000.00156.x

Woods, A. (2014). Implementing evidence into practice. Lippincott’s NursingCenter, 43(1), 4-6.

Because I am a homeless

Because I am a homeless, no one wants to hug me

But I need your hugsBecause I am a homeless, no one wants to cloth meBut I am freezing to deathBecause I am a homeless, no one wants to call me a brotherBut I know I can make you smileBecause I am a homeless, no one wants to call me a sisterBut I know I can make you smileBecause I am a homeless, I was target as less intelligenceBut I know I have skills to do somethingsBecause I am a homeless, I was treated as foolBut I know I am not a foolBecause I am a homeless, I was isolated from the societyBut I know I need friends

Because we are nurses, we want to hug youBecause we are nurses, we want to cloth youBecause we are nurses, we consider you as a brotherBecause we are nurses, we consider you as a sisterBecause we are nurses, we know you are intelligentBecause we are nurses, we know you are not a foolBecause we are nurses, we are interested in you Because we are nurses, we will always be your friendBecause we are life savers.

Greg DoganSenior Nursing StudentNDSU - Bismarck

Nursing Burnout continued from page 7

http://altru.org/careers

mailto:hr%40altru.org?subject=


ANA News

The Centers for Medicare & Medicaid Services (CMS) is readying a fraud prevention initiative that removes Social Security numbers from Medicare cards to help combat identity theft, and safeguard taxpayer dollars. The new cards will use a unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI), to replace the Social Security-based Health Insurance Claim Number (HICN) currently used on the Medicare card. CMS will begin mailing new cards in April 2018 and will meet the congressional deadline for replacing all Medicare cards by April 2019. Today, CMS kicks-off a multi-faceted outreach campaign to help providers get ready for the new MBI.

“We’re taking this step to protect our seniors from fraudulent use of Social Security numbers which can lead to identity theft and illegal use of Medicare benefits,” said CMS Administrator Seema Verma. “We want to be sure that Medicare beneficiaries and healthcare providers know about these changes well in advance and have the information they need to make a seamless transition.”

Providers and beneficiaries will both be able to use secure look up tools that will support quick access to MBIs when they need them. There will also be a 21-month transition period where providers will be able to use either the MBI or the HICN further easing the transition

CMS testified on Tuesday, May 23rd before the U.S. House Committee on Ways & Means Subcommittee on Social Security and U.S. House Committee on Oversight & Government Reform Subcommittee on Information Technology, addressing CMS’s comprehensive plan for the removal of Social Security numbers and transition to MBIs.

New Medicare Cards Offer Greater Protection to More Than 57.7 Million AmericansNew cards will no longer contain Social Security

numbers, to combat fraud and illegal use

Personal identity theft affects a large and growing number of seniors. People age 65 or older are increasingly the victims of this type of crime. Incidents among seniors increased to 2.6 million from 2.1 million between 2012 and 2014, according to the most current statistics from the Department of Justice. Identity theft can take not only an emotional toll on those who experience it, but also a financial one: two-thirds of all identity theft victims reported a direct financial loss. It can also disrupt lives, damage credit ratings and result in inaccuracies in medical records and costly false claims.

Work on this important initiative began many years ago, and was accelerated following passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS will assign all Medicare beneficiaries a new, unique MBI number which will contain a combination of numbers and uppercase letters. Beneficiaries will be instructed to safely and securely destroy their current Medicare cards and keep the new MBI confidential. Issuance of the new MBI will not change the benefits a Medicare beneficiary receives.

CMS is committed to a successful transition to the MBI for people with Medicare and for the health care provider community. CMS has a website dedicated to the Social Security Removal Initiative (SSNRI) where providers can find the latest information and sign-up for newsletters. CMS is also planning regular calls as a way to share updates and answer provider questions before and after new cards are mailed beginning in April 2018.

For more information, please visit: https://www.cms.gov/medicare/ssnri/index.html

SILVER SPRING, MD – After more than eight years of dedicated and visionary leadership, ANA Enterprise Chief Executive Officer Marla J. Weston, PhD, RN, FAAN, has announced her resignation, effective January 1, 2018.

“We are indebted to Marla for her many years of stellar leadership, helping ANA gain the visibility and impact needed to be the premier organization for registered nurses, leading change and improving health for all,” said ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN. “She has tirelessly led the Enterprise through bold transformative changes and guided us into new strategic directions.”

Since becoming CEO in 2009, in partnership with the ANA Board of Directors, Dr. Weston had led the integration of three entities, the American Nurses Association, American Nurses Credentialing Center and American Nurses Foundation, into an enterprise; strengthened the membership recruitment and retention infrastructure resulting in high growth; enabled greater coordination and impact in ANA’s advocacy work; and sharpened ANA’s focus on the programs and services it offers to nurses. These changes have built a stronger ANA Enterprise through increased strategic alignment and operational efficiency.

“It has been an honor and a pleasure to serve as the ANA Enterprise CEO,” said Dr. Weston.

ANA Enterprise CEO Weston Announces Resignation

“I am proud of how far the Enterprise has progressed and believe the time is right for me to step down. I remain deeply committed to and passionate about my profession and ANA. ”

Dr. Weston will continue in her full-time role until the end of the year, and is committed to supporting a successful transition for the new CEO. The ANA Board of Directors will engage in a search process to select the next CEO.

# # #

The ANA Enterprise is the organizing platform of the American Nurses Association (ANA), the American Nurses Credentialing Center (ANCC), and the American Nurses Foundation. The ANA Enterprise leverages the combined strength of each to drive excellence in practice and ensure nurses’ voice and vision are recognized by policy leaders, industry influencers and employers. From professional development and advocacy, credentialing and grants, and products and services through its Nursing Knowledge Center division, the ANA Enterprise is the leading resource for nurses to arm themselves with the tools, information, and network they need to excel in their individual practices. In helping individual nurses succeed—across all practices and specialties, and at each stage of their careers—the ANA Enterprise is lighting the way for the entire profession to succeed.

SILVER SPRING, MD – The American Nurses Association (ANA) is outraged that a registered nurse was handcuffed and arrested by a police officer for following her hospital’s policy and the law, and is calling for the Salt Lake City Police Department to conduct a full investigation, make amends to the nurse, and take action to prevent future abuses.

The incident occurred July 26 at University Hospital in Salt Lake City, Utah and video footage of the incident was recently released. Registered nurse Alex Wubbels was arrested after refusing to draw blood from an unconscious patient who had been injured in a collision and was a patient on the burn unit.

According to the video, Nurse Wubbels shared details about the hospital’s policy with the police officers and consulted her supervisors in responding to the detective’s request. Wubbels cited the hospital’s policy, stating that blood could not be taken from an unconscious patient unless the patient is under arrest, a warrant had been issued for the blood draw, or the patient consents. The police officers stated that they had implied consent to get the blood sample and they believed that the hospital’s policy contravened their duty to enforce the law. However, “implied consent” has not been Utah law for more than a decade. Additionally, the U.S. Supreme Court ruled in 2016 that warrantless blood tests go against privacy interests and public safety and therefore are not allowed.

“It is outrageous and unacceptable that a nurse should be treated in this way for following her professional duty to advocate on behalf of the patient as well as following the policies of her employer and the law,” said ANA President Pam Cipriano, PhD, RN, NEA-BC, FAAN.

According to the Code of Ethics for Nurses with Interpretive Statements, “the nurse promotes, advocates for, and protects the rights, health, and safety of the patient.”

Unfortunately, nurses often are victims of violence on the job. In 2015, ANA adopted a policy of “zero tolerance” for workplace violence and called on nurses and their employers to work together to prevent and reduce the incidence of workplace violence.

“Nurses and police officers work collaboratively in many communities,” said Cipriano. “What occurred is simply outrageous and unacceptable. Nurse Wubbels did everything right. It is imperative that law enforcement and nursing professionals respect each other and resolve conflicts through dialogue and due process.”

American Nurses Association Calls for Action in Wake of Police Abuse of Registered Nurse

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A Demonstration of Caring“Nursing is the essence of caring.” – Jean Watson

Nursing is a service profession with caring at its center. When asked why they want to be a part of the nursing profession, most young women and men I have met say something like, “I want to help people.” On February 15, 2017, a group of nursing students from the University of Mary Nursing Student Association (UMNSA) as well as members of the international honor society of nursing: Sigma Theta Tau-Kappa Upsilon Chapter (STT-KU) cared for others in a tangible way, by serving a spaghetti supper meal to homeless members of our Bismarck-Mandan community at Ministry on the Margins.

The idea was conceived at a new members meeting for STT-KU, during discussion of the mission and purpose of this organization. “The mission of the Honor Society of Nursing, Sigma Theta Tau International, is advancing world health and celebrating nursing excellence in scholarship, leadership, and service.” (www.nursingsociety.org). Service became one of the main topics of the meeting, particularly, how members could serve the community in a meaningful way. Members at the meeting included many University of Mary nursing students who were also members of UMNSA, and this connection proved fortuitous as part of the mission of the Nursing Student Association is also service to the greater community. To quote an early member of the North Dakota Nurses Association, “Members were not content with filling their own tasks, but sought how their efforts might benefit the whole community…” (http://ndna.org/Main-Menu/About/NDNA-History-Library/1912-34Briefhxofstateassoc.pdf). Members present at

the meeting decided that the two organizations should collaborate to do a service project.

Students at the university had taken part in clinical practice experiences at Ministry on the Margins and had also volunteered at the ministry’s weekly food pantry. This ministry was founded in 2013 by Sr. Kathleen Atkinson, OSB, after she identified a great need to help support men and women who fall through the cracks during transitional times - especially during re-entry into the community from prison. The ministry has various support groups, a morning coffee house with Bingo and Breakfast, and a food and clothing pantry. Although a very young organization, the ministry has grown exponentially in its short history, serving about 500 people each week with food, clothing, prayer, fellowship and support (Atkinson, 2017).

Because of their experiences there, students wanted to do something for the people aided by Ministry on the Margins, and a plan formed for collaboration between STT-KU and UMNSA to serve a meal. Valentine’s was chosen as a good time for sharing food and fellowship and February 15, 2017 was chosen as the target date. Sr. Kathleen was contacted and permission granted to go ahead with the project. Kelsey Meadows, a senior nursing student at the University of Mary was the project facilitator and coordinated the efforts of both organizations. She approached local businesses for monetary and goods donations. Olive Garden provided garden salad and dressing for 100 people. Sam’s Club and Walmart donated gift cards, and through the efforts of Sara Gebhardt (University of Mary nursing faculty)

On a Scale of 1 to 10... We are a 10!The Minot State University BSN Completion

Online Program is celebrating 10 years of excellence! We are a 10 because:

- Our program has facilitated the dream for numerous 2-year RNs in achieving their Bachelor of Science in Nursing (BSN) degrees over the past 10 years.

- We have bolstered the numbers of RNs educated at the BSN professional level to the workforce in North Dakota for 10 years.

- This program enables RNs to work on an individualized plan of study in order to promote a successful balance between school, work, and life commitments. We know flexibility is key to the attainment of goals!

In December of 2016, nursing was voted the “most trusted profession” for the 15th year in a row according to a Gallop poll (American Nurses Association, 2016). Nurses are at the center of health care and assume many roles. The mission of the Minot State University BSN Completion Online Program is to further enhance the preparedness of the nurse by educating individuals for professional roles in nursing and for graduate education. These nurses are the caregivers, advocates, coordinators, educators, managers, counselors, researchers, leaders and advanced practitioners who strive to promote the best possible care for the public.

How did we get to be 10 years old?? Minot State University has a rich history of generating nursing professionals with a BSN degree dating back to 1969. Prior to 2007, the MSU BSN Completion Program was offered only on campus to those with a diploma or two-year RN degrees. In 2007, the expansion to the online world was completed and the BSN Completion Online Program was born. The program has evolved into a flexible and affordable program that is available as a part or full-time model. The options include a 2 or 4 semester program as well as admitting students in both fall and spring semesters. This allows for accommodating the needs of our students and recognizing the various commitments that accompany life. We strive to meet the ever-changing needs of our students by working with their different schedules and obligations.

What are the benefits of a BSN degree, one may ask? Evidence-based practice (EBP) is the

cornerstone of nursing not only in the present, but also the future. Nurses strive to achieve excellence in their practice and the use of EBP combined with research is imperative to providing quality patient care and the best possible outcomes for the patient (Wendler et. al., 2011). The use of EBP is critical to providing the best practice for quality and safe nursing care.

The BSN graduate is educated as to the complex and evolving clinical situations that require critical thinking. The continual need for highly educated, competent and caring nursing professionals to meet the demands on a local, national and global scale. Students graduating from the MSU BSN Completion Online Program can communicate effectively via written, verbal and technological means. They also employ critical thinking to problems solve and make informed decisions while caring for patients across the lifespan. The graduates have experience in numerous types of settings to better meet the diverse needs of individuals, families, groups, and communities. Throughout their educational program, the students expand upon their knowledge of safe and quality care, promoting health maintenance, and psychosocial and psychological integrity for all. All of this is achieved by incorporating evidence-based research throughout the program.

In the Institute of Medicine (IOM) report The Future of Nursing: Leading Change, Advancing Health (2010), a goal of increasing the percentage of BSN prepared nurses to 80% by 2020 is identified. Along with this goal, the IOM also promotes nurses to practice to the full extent of their education. The MSU BSN Completion program is designed to assist the AD RN to achieve this goal! Our program’s students feel strongly about returning to school to obtain their BSN degree. Some of the many reasons the students have identified include advancing their professionalism in their career, increasing the opportunities for advancement, working at an identified Magnet status organization, obtaining personal goals, and also moving forward to pursuing an advanced practice degree.

The graduates provide feedback supporting the mission and objectives of the program. They state the educational process was a positive experience and challenges them to “promote changes for best practice.” Students feel they come away with an improved knowledge of the bigger picture that

nursing and health care plays in not only their communities, but also from a global perspective. The “program is well designed and organized” and the advising from faculty are “strengths of the program.” This program is one “I would highly recommend to a friend.”

Accreditation is critical when considering a nursing program and the Minot State University Department of Nursing Program has full approval of the North Dakota Board of Nursing. The nursing program is fully accredited by the Accreditation Commission for Education in Nursing, Inc. Minot State University is accredited by the Higher Learning Commission of the North Central Association of Colleges and Schools. A curriculum review for our program was completed in 2016 and according to the American Association of Colleges of Nursing (2007), the criteria was met that are required for BSN online completion programs.

We are so happy and excited to have the opportunity to promote and share our students’ success as they enter the professional workforce to provide excellent patient care. Their educational experience with the MSU BSN Completion Online Program gives these nurses the tools they will need to make those quick decisions using the best evidence available and to use the best practices. These are the elements essential to maintain the status of the “most trusted profession” for many years to come and this is why on a scale of 1-10... We are a 10!

ReferencesAmerican Association of Colleges of Nursing. (2007). White

paper on the education and role of the clinical nurse leader. Retrieved from http://www.aacn.nche.edu/publications/white-papers/cnl

BSN Completion Program for the Registered Nurse. (nd) Retrieved from http://www.minotstateu.edu/nursing/bsn_online.shtml

The future of nursing: Leading change, advancing health. (2010). Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. Washington, D. C., The National Academies Press.

Wendler, M. C., Samuelson, S., Taft, L., & Eldridge, K. (2011). Reflecting on research: Sharpening nurses’ focus through engaged learning. The Journal of Continuing Education in Nursing, 42(11), 487-93.

a grant for $250 was secured from Thrivent Financial. STT-KU provided cupcakes for dessert.

Over 20 volunteers from both STT-KU and NSA helped to set tables and prepare the meal of spaghetti with meatballs in marinara sauce, fresh garden salad, bread and cupcakes with lemonade and coffee. Approximately 70-80 people were served, including families with small children. Comments from some of the participants included: “I feel full and warm for the first time in a long time.,” “This is the best spaghetti I’ve ever had.,” and “This is just like my mom used to make.”

Overall, the experience benefitted both giver and receiver: members of the community who are homeless received the gift of a warm meal, fellowship and a feeling of belonging, and members of two professional nursing organizations received an education regarding the condition of homelessness and the satisfaction of providing service in a meaningful way. This project was a testament to what is possible when people and organizations work together.

ReferencesAtkinson, K. (February 15, 2017). Personal

Communication.North Dakota Nurses Association. (n.d.) A brief summary

on the history of the North Dakota Association: 1912-1934. Retrieved on 3-14-17 from: http://ndna.org/Main-Menu/About/NDNA-History-Library/1912-34Briefhxofstateassoc.pdf

Sigma Theta Tau International Honor Society of Nursing. (n.d.) Mission/Vision. Retrieved on 3-14-17 from: http://www.nursingsociety.org/connect-engage/about-stti/sigma-theta-tau-international-organizational-fact-sheet


Nurses Educational Funds, Inc., (NEF) is the largest professionally endorsed source of scholarships for advanced nursing study in the US. The NEF mission and vision encompass our two goals:

First: To promote leadership through scholarship support for professional nurses seeking masters and doctoral degrees in nursing education, practice, service and research. Second: To be the national leader in providing graduate funds for nurse leaders in education, practice, service and research.

The need for nurse leaders is critical. NEF- funded scholars have become outstanding faculty and deans of schools of nursing, renowned researchers, and experts in healthcare delivery, administration, and policy – all leading change in every arena across the country and globally. Funding scholarships for graduate nursing education is an ongoing and challenging process that has been the key focus of NEF’s volunteer board of directors.

If you are seeking to elevate your career by returning to school for a master’s or doctoral degree and seek financial assistance, our annual completely online application process at www.n-e-f.org begins on October 1 of each year and closes on February 1 of the following year. A description of the requirements for NEF Scholarship application follow.

About the Scholarships:• Scholarships are based on academic performance, a personal essay,

reference letters, and validated study already in progress in graduate programs throughout the United States.

• Scholarships are provided directly to students for their use in supporting their studies.

• A long list of named endowed scholarships is available on the NEF web-site, at www.n-e-f.org. Since 1912 over 1200 professional nurses have received a Nurses Educational Funds, Inc. Scholarship.

• Each student’s application is reviewed and scored by two separate nurse reviewers from NEF Board of Directors who do not consult with each other regarding their reviews. The review scores are then tabulated by the Criteria and Eligibility Committee nurse members for the final scholarship application determination.

About the criteria:• GREs are not required as part of the application process.• Student applicants must be licensed registered nurses with a bachelor of

science in nursing degree.• References are required from the student’s academic, employment, and

professional colleagues. • Scholarship awards are given to students in nursing research, clinical

practice, education, and administration.

About our funding:• Each year in spring and winter NEF sends letters to nurses, nursing

schools and colleges, medical centers, corporations, foundations, and individuals asking for financial support for the annual scholarships.

• Our annual Fall Gala, this year scheduled for November 1, 2017, seeks sponsorship from schools or Colleges of Nursing, medical centers, corporations, foundations, and individuals at varying levels: $50,000, $25,000, $10,000, $5,000, $2,500, and $1000. NEF Gala Reception tickets are $100.

• NEF Gala Sponsors will be acknowledged on the invitation, on the Gala Program, and during the Gala, November 1, 2017.

Nurse Philanthropy:As professionals, we can also be philanthropists, while helping others

understand the need for philanthropy. Nurses Educational Funds, Inc. will only continue to be a successful graduate nursing scholarship provider if we can mobilize a give-back spirit among our colleagues. Individual nurses can give as part of their legacy. Nurses are essential to their communities and health care but need to help their communities understand their vital health care delivery contributions. It is imperative that NEF continue to expand the number of graduate nursing scholarships if we are to facilitate and sustain nursing faculties, nurse researchers, and nursing leaders. With a give-back spirit nurses can greatly contribute to graduate nursing scholarship support.

For further information, see our web site at: www.n-e-f.org or contact our Executive Director, Jerelyn Weiss, at: [email protected], (917) 524-8051, Nurses Educational Funds, Inc., 137 Montague Street, Ste. 144, Brooklyn, NY 11201

Resources:Jerelyn Weiss, Executive DirectorSusan Bowar-Ferres, PhD, RN, NEA-BC, President of Nurses Educational Funds,

Inc., April, 2012- April 2017.Bowar-Ferres, S., Fitzpatrick, M.L., McClure, M.L. (2014, October). One hundred

years and still counting, The story of NEF: yesterday, today, and tomorrow. Nursing Administration Quarterly, 38, (4) 303-310.

Nurses Educational Funds, Inc. – Two GoalsSupport of Graduate Nursing Education Through Annual Scholarship Awards

and Mobilizing a Give Back Spirit

Brittney Sullivan, NEF Scholar, 2016-2017, on top of Table Mountain in Cape Town after presenting at the Sigma Theta Tau International

Nursing Research Congress, July 2016.

Nurses Educational Funds, Inc. Gala Reception, New York City, November 2, 2016, from left to right Susan Bower-Ferres, NEF President,

Diane Mancino, Executive Director of NSNA and Honoree, and Cynthia Sculco, NEF Vice President.

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Oral Contraceptives and Risk for CancerAppraised by:

Brittany Ness, RN; & Marie Haas, RN (Mayville State University RN-BSN students)

Clinical Question: Does taking oral contraceptives, compared to not

taking oral contraceptives, increase or decrease a woman’s risk for developing certain cancers?

Articles 1. Urban, M., Banks, E., Egger, S., Canfell, K.,

O’Connell, D., Beral, V., & Sitas, F. (2012). Injectable and oral contraceptive use and cancers of the breast, cervix, ovary, and endometrium in black South African women: Case-control study. Plos Medicine, 9(3), 1-11. doi:10.1371/journal.pmed.1001182

2. Lang, W., & Jingjing, Z. (2015). Linear reduction in thyroid cancer risk by oral contraceptive use: A dose-response meta-analysis of prospective cohort studies. Human Reproduction, 30(9), 2234-2240. doi:10.1093/humrep/dev160

3. Beaber E., Buist D., Barlow W., Malone K., Reed S., & Li C. (2014). Recent oral contraceptive use by formulation and breast cancer risk among women 20 to 49 years of age. Cancer Res, 7. 4078-4089. Abstract available: http://www.ncbi.nlm.nih.gov/pubmed/25085875

4. Gierisch, J.M., Coeytaux, R.R., Urrutia, R.P., Havrilesky, L. J., Moorman, P. G., Lowery, W. J., Dinan, M., Mcbroom, A. J., Hasselblad, V., Sanders, G. D. & Myers, E. R. (2013). Oral contraceptive use and risk of breast, cervical, colorectal, and endometrial cancers: A systematic review. Cancer Epidemiology,

of contemporary oral contraceptive formulations is associated with an increased breast cancer risk among women ages 20 – 49.3

In the final important study a systematic review was done to estimate associations between oral contraceptive use and breast, cervical, colorectal, and endometrial cancer incidence. Searches of PubMed, Embase, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov was done to identify relevant published literature and were restricted to the year 2000 and on. This study supports that the use of oral contraceptives may cause an increased risk of breast cancer and a decreased risk of endometrial and colorectal cancer.4

Bottom Line We were able to find that oral contraceptives do

in fact affect a woman’s risk for developing certain cancers. We found that oral contraceptives appear to increase a woman’s chances of developing breast, cervical, and liver cancer, while oral contraceptive use decreases a woman’s chances of developing ovarian (specifically type 2 ovarian cancer), endometrial cancer and colorectal cancer. The significance in increased or decreased risk varied with birth control formulations and length of use. All medicines carry risks. To decide whether to proceed with a particular treatment, one should always consider the balance between benefits and risks. Birth control pills are one of the most effective means of contraception, not to mention their assorted other health benefits. Thus, women should discuss the benefits and risks with their doctors in order to choose the options that best fit their needs.

Implications for nursing practice • Nurses can take the information from

this research and educate themselves on the risks/benefits of women taking oral contraceptives.

• Education should be given to women with information regarding the risks/benefits of taking oral contraceptives including cancer risk.

• Health care professionals working with women in reproductive health should be helping patients make informed decisions whether or not oral contraceptives are a right choice for them.

• Raising awareness regarding women at risk for certain hereditary cancers and their associated risk with oral contraceptives is important.

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QUALIFICATIONS:Registered Nurse or Social Worker licensure in North Dakota. Effective verbal, nonverbal and written communication skills. Previous supervisory or management experience. The mental and physical health sufficient to meet the demands of the position.

To apply, please contact Mandy Swain at (701)-477-1949 or [email protected].

Applications are also available online at: www.pmc-rolla.com

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The North Dakota Department of Health has employment opportunities for REGISTERED NURSES, DIETITIANS

AND QUALIFIED INTELLECTUAL DISABILITIES PROFESSIONALS (QIDP) as a Health Facilities Surveyor.

How would you like every weekend to be a three-day weekend plus have ten paid holidays each year?

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Synthesis of evidence Our team reviewed 12 articles looking to find any

associations with women taking oral contraceptives, and their risk in developing or preventing certain cancers. Four of our articles found good evidence regarding our question.

In the first study researchers in South Africa wanted to determine whether or not oral contraceptive use may influence risk of cancers of the female reproductive system in black African American women. In a case-control study of 5,702 African American women that self-reported oral contraceptive use and were diagnosed with either breast, cervical, ovarian, or endometrial cancer, evidence was found that women had an increased risk for breast and cervical cancer with longer duration of oral contraceptive use, and a decreased risk for ovarian and endometrial cancer with longer duration of oral contraceptive use.1

In the second study that was a systematic review and meta-analysis, it looked for associations between thyroid cancer risk in females and oral contraceptive use. The study was a meta-analysis of 9 cohort studies with 1,906 participants that took place over the course of 7.5-15.9 years. The study found a significant inverse association between the longest vs. the shortest duration of oral contraceptive use and risk of thyroid cancer. This study found that longer periods of oral contraceptive use decreases a woman’s risk for thyroid cancer.2

The third study was a case-control study conducted in the US on more recent formulations of oral contraceptives of females enrolled in a large US integrated health care delivery system and breast cancer risk. The findings suggest that recent use

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Childhood ObesityAppraised by:

Jami Gage RN, Caitlin Hanson RN, Chyrstel Timoh RN (Mayville State University RN-to-BSN students)

Clinical question: In school aged children, how does a school

implemented program to prevent childhood obesity impact overall obesity rates in that school compared to schools who do not implement an intervention program?

Articles:Brown, T., & Summerbell, C. (2009). Systematic

review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: An update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obesity Reviews, 10(1), 110-141. doi:10.1111/j.1467-789X.2008.00515.x

Rerksuppaphol, L., & Rerksuppaphol, S. (2017). Internet based obesity prevention program for Thai school children- A randomized control trial. Journal Of Clinical & Diagnostic Research, 11(3), 7-11.doi:10.7860/JCDR/2017/21423.9368

Shofan, Y., Kedar, O., Branski, D., Berry, E., & Wilschanski, M. (2011). A school-based program of physical activity may prevent obesity. European Journal of Clinical Nutrition, 65(6), 768-770.doi:10.1038/ejcn.2011.25

Wendel, M. L., Benden, M. E., Hongwei, Z., & Jeffrey, C. (2016). Stand-biased versus seated classrooms and childhood obesity: A randomized experiment in Texas. American Journal Of Public Health, 106(10), 1849-1854. doi:10.2105/AJPH.2016.303323

Synthesis of evidence: Our goal from this PICO question was to use

recent studies within the past 10 years to address school implemented programs vs. those without, to come to a conclusion to our question. Childhood obesity is a growing concern and is a controversial topic. This topic directly correlates to nursing, as nurses can assist in health promotion and disease prevention across the lifespan. If nurses have a better understanding on if school implemented health programs have an effect on childhood obesity, they can advocate for further health programs.

We researched 18 evidence-based practice articles to come to our conclusion. Of those 18 articles, we narrowed it down to the 4 most significant articles. Three of the articles were studies with a control and intervention group and one article was a systematic review of multiple research studies.

The first study by Wendel, Benden, Hongwei, and Jeffrey (2016), objective was to determine if the implementation of stand-biased classrooms in 3rd and 4th grade helped decreased students body mass index (BMI) percentiles. The study found that changing classrooms to a stand-biased environment had a significant effect on lowering the students BMI percentile over the 2-year period. Changing classroom to stand biased can interrupt sedentary behavior patterns of students at a low cost without interrupting classroom time.

The second study by Rerksuppaphol and Rerksuppaphol (2017), had an objective to assess how effective the implementation of an internet based obesity prevention program was in school children in grades one to six in schools in Thailand. It was found that the control group had a higher percentage of overweight/obesity than the intervention group. It was also found that children in the control group had a significantly higher increase in net BMI gains than those in the intervention group. The conclusion of the study was that an internet based obesity prevention program was effective in modifying anthropometric outcomes and helped to address the rising prevalence of overweight and obese status in Thai school children.

The third study by Shofan, Kedar, Branski, Berry, and Wilschanski (2011), objective was to assess two separate elementary schools using a control and intervention group that had additional exercise and nutritional programs. The intervention group was shown to have a decreased BMI after the two years was over. In conclusion, the study does suggest that school-based intervention programs do in fact support a prevention in obesity compared to those without.

The last study by Brown and Summerbell (2009) had an objective to determine the effectiveness of school-based interventions. This study specifically focused on school-based interventions which focused on changing dietary intake and

increasing physical activity levels. Though the findings were inconsistent throughout the 38 studies that this article reviewed, findings still suggested that school-based dietary and physical activity programs helped to prevent children from becoming overweight.

Bottom line:Research suggests that there is a direct

correlation between childhood obesity and school implemented programs. Although there is not an exact obesity rate that can be compared from all combined studies, studies do suggest that schools with a school implemented intervention program tend to have a lower childhood obesity rate than those without. Many studies on school-based interventions had multiple interventions in place to prevent obesity. More research needs to be done on what specific interventions had the most effect on childhood obesity.

Implications for nursing practice:Childhood obesity has become a global public

health crisis and urgent measures should be implemented to help eradicate this societal epidemic. Through this study, it has been observed that a promising avenue through which childhood obesity can be reduced and eliminated is through the implementation of school-based programs to prevent obesity among school-going children. The above insights derived through this study greatly impacts the nursing profession.

Nurses play an important role in the healthcare system. One of the primary objective of nurses is to foster proper health and well-being of the populations through effective health promotion. The understanding that by implementing school-based programs to reduce childhood obesity can be effective in reducing the health burden of this societal epidemic should galvanize nurses to play an active and leading role in promoting the implementation of similar programs across schools in the country. In addition, the educative and teaching role of the nursing practice will be enhanced further as nurses will be motivated and obligated to work with schools and educate them on how to make these school-based obesity reduction programs more effective to increase their value.

That research paper isn’t going to write itself.

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Asthma and Vitamin D

Prenatal Care

Appraised by: Tisha Kamrowski, RN; Azie Nkwainguh, RN; &

Jennifer Stauffer, RN (Mayville State University RN-to-BSN students)

Clinical question:In children with asthma, how does vitamin

D supplementation affect the number of asthma attacks compared to those children who do not take vitamin D supplementation?

Articles:Cassim, R., Russel, M.A., Lodge, C.J., Lowe, A.J.,

Koplin, J.J., & Dharmage, S.C. (2015). The role of circulating 25 hydroxyvitamin d in asthma: A systematic review. Allergy, 70(4), 339-354. doi: 10.1111/a11.12583.

Riverin, B.D., Maguire, J.L., & Li, P. (2015). Vitamin d supplementation for childhood asthma: A systematic review and meta-analysis. Plos ONE, 10(9), 1-16. doi:10.1371/journal.pone.013684.

Martineau, A.R., Cates, C.J., Urashima, M., Jensen, M., Giffiths, A.P., Nurmatov, U., … Griffiths, C.J. (2017). Vitamin d for the management of asthma. Cochrane Database of Systemic Reviews, (1), doi: 10.1002/14651858.CD011511.pub2.

Yakoob, M. Y. (2016). Vitamin D supplementation for preventing infections in children under five years of age. Cochrane Database Of Systematic Reviews, (11), doi:10.1002/14651858.CD008824.pub2

Synthesis of evidence:Asthma is a chronic inflammatory condition

involving the airways which can present as wheezing, cough, chest tightness, and shortness of breath, also known as an asthma attack, which is the leading cause of morbidity and mortality in individuals with asthma (Martineau et al., 2016). If vitamin D supplementation can decrease the rate of asthma attacks, it would be an easy preventive measure that could improve the lives of many children with asthma. The initial search on the Mayville State University database yielded eighteen research articles that after critical appraisal was narrowed down to four level one

evidence articles that contributed to the following information:

• There is some evidence of the reduction of asthma exacerbation with vitamin D supplementation in children with asthma and total monthly doses of 60,000 IU of vitamin D may prevent ED visits (Riverin, Maguire, & Li, 2015).

• Low levels of vitamin D in children with asthma were associated with an increased risk of asthma exacerbation requiring medication for treatment or hospitalization (Cassim et al., 2015).

• Administration of vitamin D supplementation resulted in a significant reduction in the rate of asthma exacerbation requiring treatment with corticosteroids, emergency room attendance, and hospitalization (Martineau et al., 2017). These results were primarily in adults but is promising for children.

• “A vitamin D deficiency can lead to rickets and has been linked to various infections, including respiratory infections” (Yakoob, 2016, p. 1).

Bottom line:Vitamin D supplementation in children with

asthma to reduce asthma attacks would be an easy preventive measure to improve the outcome for children with asthma. Vitamin D deficiency leads to an increase in infections so this may be the main reasoning behind the decrease in asthma exacerbation with vitamin D supplementation as respiratory illnesses can increase asthma symptoms. Preventing just one asthma attack in a child may save that child’s life so continued research into preventive measures is needed.

Implications for nursing practice:Due to increased controversies on the role

of vitamin D in reducing asthmatic symptoms, researches like this are very important to nursing because they help nurses to understand the importance of administering vitamin D to children and its role in reducing asthmatic symptoms. In addition, nurses have the responsibility of educating their patients, conducting this type of research will enable nurses to acquire the knowledge that they need to better educate their patients.

Appraised by: Maranda Jenson, RN; Alain Foryim, RN; &

Trisha Peterson, RN (Mayville State University RN-to-BSN students)

Clinical question: In pregnant women, does regular prenatal care

versus no prenatal care impact fetal outcomes?

Articles: Benediktsson, I., McDonald, S. W., Vekved, M.,

McNeil, D. A., Dolan, S. M., & Tough, S. C. (2013). Comparing CenteringPregnancy® to standard prenatal care plus prenatal education. BMC Pregnancy & Childbirth, 13(Suppl 1), 1-10. doi:10.1186/1471-2393-13-S1-S5

Noonan, K., Corman, H., Schwartz-Soicher, O., and Reichman, N. (2013). Effects of Prenatal Care on Child Health at Age 5. Maternal & Child Health Journal, 17(2), 189-199.

Sunil, T., Spears, W., Hook, L., Castillo, J., & Torres, C. (2010). Initiation of and barriers to prenatal care use among low-income women in San Antonio, Texas. Maternal & Child Health Journal, 14(1), 133-140. doi:10.1007/s10995-008-0419-0

Till, S. R. (2015). Incentives for increasing prenatal care use by women in order to improve maternal and neonatal outcomes. Cochrane Database Of Systematic Reviews, (12), doi:10.1002/14651858.CD009916.pub2

Synthesis of evidence: “Healthy People 2010 goals set a target of 90%

of mothers starting prenatal care in the first trimester of pregnancy” (Sunil, et al., 2010, p. 133). At the time of that writing “Studies find that 60% of women do seek prenatal care within the first trimester of pregnancy” (Sunil, et al, 2010, p. 134). There are several maternal factors that impact the utilization of regular, routine and recommended prenatal visits and these factors have been linked to the outcomes of the infant at the time of birth and during the first year of life.

A second study investigated the health of children at the age of 5 for mothers who received prenatal care during pregnancy where socioeconomic and sociodemographic impacts were considered. The study indicates that there are possible health benefits that only become apparent after the perinatal period (Noonan, et al., 2013). The study indicated a direct

correlation between adult disease in mothers and the offspring resulting from adverse intrauterine environment. Acute respiratory infections, asthma, and ear infections in infants were found to result from second hand smoke. Smoking habits are practices that can possibly be stopped if mothers receive prenatal care, thus improving the health of offspring later in life. This study, however, is inconclusive and suggests further studies on the impact of prenatal care on a child’s health from birth and beyond.

In a third study, the use of incentives were given to increase the percentage of mothers receiving prenatal care. The purpose of the incentives is to have more mothers receive prenatal care to improve their health and their infant’s health. The aim of good prenatal care is to detect, prevent, or treat any problems if detected. Prenatal care can also increase the chances of having a healthy infant. (Till, 2015). The study shows that there was not enough evidence to determine the effectiveness of incentive programs. Prenatal care can reduce risk of newborn mortality and low birth weight, along with other potential problems.

The final study discussed the use of group prenatal care education compared to individual prenatal care education. “In prenatal education classes, an instructor presents content that generally addresses child birth and maintaining a healthy pregnancy, but may also cover infant care and the early postpartum transition, to a group of pregnant women and their chosen support person” (Benediktsson, et al., 2013, p. 1). These prenatal classes can help a mother learn what to expect and how to address child birth, how to maintain a healthy pregnancy, reduce adverse birth outcomes, and may address infant

care. Both types of educational classes have a common goal: for the mother and infant to be as healthy as possible throughout the pregnancy and child birth process. This study supports that two different types of education can be used to increase the knowledge of prenatal care; however, the study does not say which type of education, individual or group, is more effective.

Bottom line: Based on the information obtained from

research, it was discovered that regular prenatal care would have a greater impact on the outcomes of a mother and infant. It was found that economic status and geographical location influence the mother’s ability to seek regular prenatal care, if any prenatal care at all. Inadequate or no prenatal care can have direct effects on the infant such as preterm birth, low birth weight, and infant mortality. It is strongly recommended for mothers to be educated about prenatal care as early as possible. Prenatal care can have significant results for their own health and their infant.

Implications for nursing practice: When mothers do not or are unable to seek

prenatal care, there are risks to the health and wellbeing of both mother and infant. Nurses need to be aware of potential poor outcomes and complications that may arise during birth and the months following birth. Nurses can advocate for better utilization of prenatal services. Prenatal care services can help pregnant women engage healthier behaviors such as smoking cessation, quitting alcohol, and managing health conditions that are important for mothers and their unborn infants.

New Wage Scale!

Presentation Medical Center is currently hiring Registered Nurses to work in the Emergency Room and Acute Care settings.

To apply, please contact Mandy Swain at (701)-477-1949 or [email protected].

Applications are also available online at: www.pmc-rolla.com

REGISTERED NURSES

Northwood Deaconess Health Centeris looking for passionate, patient-focused

RNs and LPNsto join our skilled nursing team.

Sign on Bonus:Up to $10,000 - Full Time RN • Up to $5,000 - Part Time RN

Interested applicants contact: Tami Rygg, RN/DON at

701-587-6487 [email protected]

www.ndhc.net


NDNA10

Join NDNA Now! Use form provided or go to www.NDNA.org

Appraised by: Paula Mannie, RN; Cailley Martel, RN; Brent

Amerud, RN; Mayville State University RN-to-BSN students

Clinical question: How does shift report at the bedside versus shift

report at the nurses’ station affect patient safety and patient care in an acute care setting?

Articles:Maxson, P. M., Derby, K. M., Wrobleski, D. M.,

& Foss, D. M. (2012). Bedside nurse-to-nurse handoff promotes patient safety. MEDSURG Nursing, 21(3), 140-145.

Tan, J.K. (2015). Review Paper. Emphasizing Caring Components in Nurse-Patient-Nurse Bedside Reporting. International Journal Of Caring Sciences, 8(1), 188-193.

Sand-Jecklin, K., & Sherman, J. (2014). A quantitative assessment of patient and nurse outcomes of bedside nursing report implementation. Journal Of Clinical Nursing, 23(19/20), 2854-2863.

Agency for Healthcare Research and Quality. (2017). Nurse bedside shift report. Retrieved from https://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy3/index html.

Synthesis of evidence: The evidence found in our articles all supported

our PICO question in that bedside report provides better patient satisfaction and safer quality care than report at a nurse’s station. Our information was found through using Mayville State University’s online library databases.

We also found credible webpages providing information about bedside shift report. Key search words included bedside shift report, safety of bedside report, and transforming care at the bedside (TCAB). Through these searches we were able to find valid and reliable information to support bedside report. Articles expressed how patients felt safe and that they could trust their nurses. Bedside report was also shown to have caring components. Overall the studies were shown to enhance the nurse to patient relationship. Patients and families felt more involved and included in the patient’s plan of care. Bedside reporting also showed to reduce errors such as medication errors.

Bottom line: The research concludes that bedside reporting

has a higher level of professional quality and overall patient safety when conducted in a systematic fashion and includes the patient within the scope of reporting. Nurse station reporting can be beneficial to the patient and staff in terms of care planning; procedures and floor policies related to safety but also disregards a certain level of confidentiality for individual patients along with added distractors within the hospital environment.

Implications for nursing practice:It is found that bedside shift reporting greatly

increases overall safety and communication, patient and nurse satisfaction, allows patients to trust their nurses, and decreases risk of error. Nurses should be aware that bedside reporting allows patients and their families to be involved in the plan of care, and gives them time to ask questions as needed.

Shift Report at the Bedside

HELP WANTEDRN or LPN

Full-time or part-time position. Variety of shifts. Recently increased competitive wages, PTO, extended sick leave, etc.

For More Information ContactJenny Westphal RN, DON

701-242-7891St. Gerard’s Community of Care

Hankinson, NDWebsite: Stgerards.org

http://www.trinityhealth.org

HolidayGreetingsfrom the North Dakota Nurses

Association Board & Staff

http://ndsu.edu/nursing

http://healthcare.goarmy.com/

Vol. 86 • Number 4 November, December 2017, … · donelle.richmond@Nicole Scherr Sherry Burg,...

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Transcript of Vol. 86 • Number 4 November, December 2017, … · donelle.richmond@Nicole Scherr Sherry Burg,...