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Princeton, MNPermit No. 14

THIS ISSUE

INSIDEANA IDAHO PRESIDENTIAL REPORT

IDAHOFeb, Mar, April 2019Volume 41, • No. 4

Official publication of Idaho Alliance of Leaders in Nursing & Idaho Center for NursingQuarterly publication direct mailed to approximately 25,000 RNs and LPNs in Idaho.

These organizations are members of the Idaho Center for Nursing.

Brie Sandow, MSN, RN, NEA-BC, RNC-OBANA Idaho President

Email: [email protected]

The American Nurses Association (ANA) provides many learning opportunities and I have been fortunate to be engaged in and to take advantage of many of them. This year, I heard a national speaker talking about the keys to being successful both individually and as an organization. Each of these aspects shared the same three activities skills: surveying, collaborating, and communicating.

Surveying is about looking to see what opportunities exist that can help to move you and your career ahead. It is also what we use to identify barriers and, hopefully, unintended consequences. We know from being in the workplace that there are nurses that continually survey the landscape for opportunities, whether those are about career advancement and job change or from the professional perspective of being a nurse and constantly surveying what is happening to patients and the workflow.

Becoming Successful,How We Can Do This Together

Collaborating is a cornerstone of success both at work and individually. So often we hear successful people credit others that they have collaborated with for the success that they are being recognized for. We want to think of ourselves as always being collaborative, but to fully embrace that trait, we have to be open to saying yes to opportunities.

Communicating is the tool that holds the other two together. Without communication, what we survey and who we collaborate with will not be able to maximize the opportunities that are possible.

Beyond a personal application of these three aspects, I want to share with you the surveying, collaborating and communicating that is happening within Idaho nursing and how ANAI is engaged. Last fall, the ANAI board, along with most of the other professional nursing associations in Idaho, decided to join the newly formed Idaho Center for Nursing. In November we had the first group meeting, which was very collaborative and informative about what each organization was focused on in terms of member benefits, retaining and recruiting members, and upcoming legislative issues; it was also a good session to ask and answer questions.

In terms of surveying, ANAI conducts ongoing surveying (environmental scans) to identify issues. Recent scans show that nurses continue to be most concerned about workplace violence, followed by concerns about nurse staffing because

Brie Sandow

Nurses for Idaho! Don’t Miss Out

Join us for Nurses Day at the Capitol, February 21st, 2019

Presidential Report continued on page 2

FEATURE: Success of a Nurse Residency Program in a Critical Access Hospital Franci Marks, BSN, RN PAGE 5

FEATURE:The Evolving Landscape of Non-Cancer Opioid Prescribing: Risk Mitigation as a BaselineMelanie Nash, DNP, APRN PAGE 7

Letter from the Editor Sydney Parker, MSN, RNC-OB PAGE 2

Executive Director ReportRandall Hudspeth, PhD, APRN-CNP/CNS, FAANP PAGE 3

Save the Dates PAGE 4

Self-Care Corner: Be Mindful, Be PresentKatie Roberts, MSN, RN PAGE 4

Advocacy in Action: 2019 Idaho Legislative SessionMichael McGrane, MSN, RN PAGE 6

AWARDS AND RECOGNITIONS:Nursing Recognitions PAGE 8

AWARDS AND RECOGNITIONS:Nurse Leaders Peer Group of the Northwest Hospital Alliance Receives the Idaho Rural Health Heroes AwardMary Ann Reuter, Executive Director, IHRA

Kevin McEwan, MSN, RN Voted toAONE Board of Directors PAGE 9

IDANA Presidential UpdateGus Powell, MSN, CRNA PAGE 10

STUDENT SPOTLIGHTS:Students Shine at Lewis Clark State College Nursing Symposium Sydney Parker, MSN, RNC-OB

Human SIM Lab at Idaho State UniversityLee Ann Hancock and Lindsey Taylor PAGE 11

In Memoriam PAGE 12

Update from the Idaho Board of NursingSandra Evans, M.A.Ed., RN PAGE 13

Update from IALN/NLIKaren Neill, PhD, RN, SANE-A, DF-IAFN PAGE 14

ANA Membership PAGE 15

• RN Idaho February, March, April 2019

RN Idaho is published by Idaho Alliance of Leaders in Nursing

& Idaho Center for Nursing6126 West State St., Suite 306

Boise, ID 83703

Direct Dial: 208-367-1171 Email: [email protected]: www.idahonurses.org

Editorial Board: Sydney Parker, MSN, RNC-OBSusan Cline, DNP, MBA, RN, NEA-C Margo Hickman, BSN, RNRandall Hudspeth, PhD, APRN-CNP, FRE, FAANP, ANA Idaho Executive Director (advisory)Beverly Kloepfer, MSN, RN, NP-C Barbara McNeil, PhD, RN-BC, Editor EmeritaGus Powell, MSN, CRNAKatie Roberts, MSN, RNMark Siemon, PhD, RN, APHN-BC, CPHChristine Westrup, BSN, RN

RN Idaho welcomes comments, suggestions, and contributions. Articles, editorials and other submissions may be sent directly to the ANA Idaho office via mail or e-mail. Please call the ANA Idaho office if you have any questions.

JOIN ANA IDAHO TODAY

WE NEED YOU!Membership applicationhttp://nursingworld.org/joinana.aspx

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]. ANA Idaho 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 ANA Idaho 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. ANA Idaho 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 ANA Idaho or those of

the national or local associations.RN Idaho is published quarterly every

February, May, August, and November for the Idaho Alliance of Leaders in Nursing and the

Idaho Center for Nursing.

IDAHO

ANA Idaho Welcomes New & Returning Members

September 2018 - December 2018

American FallsJessica Schott

AmmonAmy Hope

BoiseMarie BermanDori HealeyLucas DonaldsonMaryse BarkerJulia KochKelly HurleyRachel AavangLisa HotchkissTammy GallagherChristine ChandlerKarol StaffordRoberta ChilcoteLinda CrawfordSharon HayhurstAlicia Jones

BurleyTephra Oman

Coeur D’AleneMelissa QuaidBeverly OhJan Moseley

EagleMichael McGraneNoreen Davis

FilerSharon Willmore

HaydenWendy De BlaquiereJanice Matthews

Idaho FallsEmily Mangas

KimberlyErica Sommer

KunaTeresa Dixon

LenoreJoan Agee

LewistonJessica BringmanJason Steik

MeridianLori McBrideSusan Tavernier

MoscowAndrea Henson

NampaLinda BrotckeKelti BakerCourtney KirkpatrickTina WilliamsCherese Tarter

PocatelloPatricia YoungColleen PerkinsAnn VodaCynthia Rice

Post FallsPamela Bertram

PotlatchChris Land

PrestonAmy Jensen

RathdrumTheresa Foster

ShelleyBrianne Tolman

Twin FallsBrenna KlingerMichelle Harcourt

WallaceLouisa Clark

Sydney Parker, MSN, RNC-OBEmail: [email protected]

Hello fellow Idaho nurses! The season of advocacy and change is upon us. Nurses have powerful voices and the profound ability to influence change. Events on February 21-22 (See “Save the Dates”) focus around the calling of nurses to advocate in the political arena and collaborate as a profession at the state level. I hope this season you find the power in your voice, whether through political activism at the Sydney Parker

Capitol, authorship for RN Idaho, or engagement in your workplace.

Here at RN Idaho, we continue to be excited about recognition, collaboration, and advancing the profession through your scholarly work. “Student Spotlights” will continue to feature notable student nurse contributions and highlights from schools of nursing. The Idaho Center for Nursing (ICN) provides an umbrella that fosters partnerships between the various organizations in Idaho and we would love to hear from yours. We also hope you will send us recognitions from your special events, as well as share current research, evidence-based practice and quality improvement projects. We look forward to continuing to foster growth, connection, and the ongoing celebration of your accomplishments and dedication to the profession.

Until next time, Sydney

LETTER FROM THE EDITOR

increasing number of nurses are approaching retirement and the numbers of new nurses entering the workforce remains stagnant. With increasing patient numbers and severity of illness, the demand on nurses will continue to intensify, thus impacting staffing needs. The ANA is working to address these issues on a national level in terms of staffing guidance. They are also in collaboration with the American Organization of Nurse Executives (AONE) and the hospital association. Salaries have long been an issue, but our 2018 salary survey showed that Idaho nurse salaries rank third out of the six surrounding states, compared to 7 of 7 in 2012.

Collaboration is best showcased by our support of shared governance initiatives that allow beside nurses to have a strong role in decisions that impact the workplace. To maximize collaboration, we rely on experience-based decisions that benefit the majority and consider the needs of many. Collaboration is not always easy, and it requires that we address the variables that have an impact, such as funding and technology. It also means that we advocate for a seat at the decision-making table and have an opportunity to share our views.

Currently in Idaho, nurses have a lot going for them. There is a body of evidence that demonstrates that schools of nursing collaborate well through articulation agreements. Additionally, agencies support nursing education both financially, with staffing support, and by increasing clinical placement opportunities for students, resulting in increased number of nurses. Nurses have had collaborative roles with support for legislation, such as the passage of Proposition 2, developing new programs to support the underserved, and removing barriers to accessing care, especially in rural communities.

Communication with each other, both within Idaho and nationally, to present the concerns and contributions of Idaho nurses is important to showcase success and to support these contributions. ANAI is focused on that communication. The ANAI annual conference this February, our newly designed website, and the changes to RN Idaho are examples of ongoing communication targeted at all nurses. I encourage each of you to visit the ANAI website, and if you are not a member, at least be a “follower” of ANAI so you can be better informed by receiving the announcements.

I am looking forward to seeing many of you at the Legislative Day and Annual Conference.

Presidential Report continued from page 1

February, March, April 2019 RN Idaho •

Randall Hudspeth, PhD, APRN, FRE, FAANP

Executive Director, Idaho Center for NursingEmail: [email protected]

Exercising your right and responsibility to attain membership in a professional organization is like exercising your right to vote in an election. Both are always encouraged, yet often neglected and hard to keep people engaged for a variety of reasons.

I have thought much about why nurses choose to join their professional associations and what makes them renew their membership year after year—and what happens that prevents those things from happening. Realizing that most nurses do not feel the need to belong to multiple organizations and knowing they choose the one organization that most meets their needs, either through continuing education offerings, association or advocacy, we can ask ourselves what is the membership attraction? Is membership driven by what individuals think they can get out of the organization, or is it driven by members wanting to be a part of something bigger than themselves?

Without a doubt, membership numbers impact organization sustainability and the organization’s influence to represent nursing in the state. The Idaho Center for Nursing works regularly with the American Nurses Association of Idaho (ANAI), the Idaho Association of Nurse Anesthetists (IDANA), Nurse Leaders of Idaho (NLI) and the Nurse Practitioners of Idaho (NPI). Each of these are independent membership organizations that have affiliate relationships with their respective national membership organizations. Each of these organizations also has a core group of long-term members and none are near their full membership potential in Idaho.

As of December, Idaho has 18,998 licensed RNs that live in the state. About 5,000 more RNs are licensed in

Randall Hudspeth

Thoughts on Membership…It is like Voting!

Idaho, but they do not live in the state. Subtracting the 2,700 APRNs who could be members of NPI or IDANA, that yields about 16,000 RNs who could join ANAI. Actual membership is about 650. So, what has happened to these 15,350 RNs who choose not to invest $15.00 a month into the profession?

Personally, I have had my own issues with membership and early in my career, I also looked to membership from the viewpoint of “what is in this for me and what will I get back for this money?” I had to grow-up a bit and then I realized that even if I never got anything personally, just the satisfaction that the profession was able to advance itself and that maybe my membership helped that advancement in some small way, was in itself all that I should expect or need.

I believe that history is a good teacher. The history of the nurses association in Idaho is no different than most rural Western states. These associations have lots of area to cover, and usually the majority of members and activities are focused in one city, causing rural nurses to consistently feel disenfranchised. A membership organization would take time, and for these nurses, the demands of family, work, and church do not allow for extra time. Historically, the high points of the Idaho Nurses Association membership were the 1950s and 1960s when annual membership was near 900 RNs and the total number of RNs in the state was about 7,000, accounting for about 13% of RN belonging compared to today’s 2% of nurses belonging.

Professionally, at the end of the day membership is important. Giving up three fancy coffee drinks a month will easily pay the $15.00 monthly dues. I cannot easily convince nurses that they should join or that they will get an easily seen direct benefit. What I can say is that based on a 40 year career, I have seen all nurses advance because of professional organization engagement. The membership support of the few has impacted the careers of the many. It is like voting. The votes of a minority of the population serve to impact all of the population. Bottom line…join whatever professional nursing organization that aligns with your practice. The most important professional action you can take is membership. Do your part….JOIN!

EXECUTIVE DIRECTOR REPORT

Nurse’s Opinions Count…Share Yours!

ANAI is conducting the 2019 Nursing Opinion Survey to evaluate how nurses are impacted by current issues to determine ANAI’s engagement and resource use with each area of concern.

Please complete the online survey at:

https://www.surveymonkey.com/r/

JN3YJHMOr use the QR code:

Council for Nurse Education Leaders (CNEL) Update

Krista Harwick, DNP, APRN, NP-CCNEL President and Region 2 NLI Representative


The Council for Nurse Education Leaders (CNEL) is an organization comprised of the Deans and Chairs of all nursing education programs in Idaho. The purposes of CNEL are to:A. Communicate purposes,

contributions, and needs of nursing education programs to professional groups, the public, and government officials.

B. Strengthen liaisons among nursing education, nursing practice, and nursing research through board membership in Nurse Leaders of Idaho (NLI), and through partnership and collaboration with all participating organizations of the Idaho Center for Nursing.

C. Serve as a network representing all Idaho nursing education programs.

D. Communicate and collaborate with professional organizations to promote nursing education in Idaho (relevant associations, schools of nursing in the region).

E. Facilitate opportunities for articulation of nurses from one level of nursing education to the next.

F. Critically analyze legislative initiatives for their impact on nursing education in Idaho and the nation.

Over the past six months, CNEL members reorganized with a goal of providing a unified voice for nursing education, and promoting articulation through academic and practice collaborations throughout the state of Idaho. Idaho schools of nursing have a long history of working together to establish articulation plans and collaborations that positively impact the Idaho nursing workforce. In support of the Institute of Medicine (IOM) recommendation that 80% of RNs be prepared at the baccalaureate level or higher by 2020, Idaho academic institutions have developed innovative pathways to meet this goal. Lewis-Clark State College, North Idaho College, and the College of Western Idaho developed plans that allow students enrolled in community college nursing programs to concurrently enroll in online baccalaureate program courses known as the CC-BSN Pathway (community-college to BSN).The curriculum plans allow students to graduate with their baccalaureate degree in nursing in one to two semesters following completion of their associate degree. The first cohort of students in the pathway began summer 2018, and is anticipated to complete associate degrees in spring 2019, and baccalaureate degrees in fall 2019.

In July, CNEL members voted to establish a more formal collaboration with Nurse Leaders of Idaho (NLI) and by recommendation of the NLI Academic & Practice Committee, a change to the NLI by-laws was proposed to add one board position to be filled by the President of CNEL. In November, by unanimous vote, NLI members approved the by-laws change, and the new CNEL board representative will begin their term in January 2019.

Krista Harwick

#ISaidWhatIWant — Have You?

Stephanie Bender-Kitz, PhDProject Lead


Nearly 20 specialty nursing organizations representing more than 700,000 nurses have joined together to promote advance care planning (ACP), encouraging nurses to lead by example and create their own advance care plan. Even though most nurses are familiar with ACP, many do not have their own plan in place. This initiative is helping nurses create their own plan.

Advance care planning (ACP) is an ongoing process to help individuals and their families think about, discuss, and document their goals and values for medical care in life-threating and end-of-life situations. In situations where an individual can’t participate in their medical decisions, the ACP guides the family and health care providers in providing care that honors and supports the individual’s wishes.

The #ISaidWhatIWant campaign was developed in response to work done at the 2017 Palliative Nursing Summit hosted by the Hospice and Palliative Nurse Association (HPNA). The Summit brought together nurses from various specialties to develop a collaborative agenda regarding advance care planning, pain and symptom management, and transitions/coordination of care. One result is this campaign, engaging nurses nationwide to lead by example to enhance the care and outcomes for their patients and families (https://advancingexpertcare.org/ACP).

#ISaidWhatIWant starts with nurses. While all members of the health care team participate in treatment discussions, nurses are in a unique position to champion ACP with patients and families. Nurses have regular, ongoing conversations with patients and are trusted to provide important information and quality care.

What better way for nurses to demonstrate the value of advance care planning than to share with your patients and families that you’ve done your own planning. Lead by example and think about what you want, talk with your loved ones, and establish your own advance care plan. Saying what you want is a great gift to your family members if they ever have to make difficult health care decisions on your behalf.

There are great resources in Idaho to assist with ACP. Honoring Choices® Idaho, a program of the nonprofit Jannus, offers free materials, training, and consultation to help health care professionals build their ACP skills and knowledge. Honoring Choices® Idaho also offers free education materials, an easy-to-use advance directive document, and depending on where you live, free trained ACP facilitators to guide you and your family through an ACP conversation. Honoring Choices® Idaho is working with health care and community organizations across the state to inspire ACP conversations as a routine part of good health care. Learn more and use the materials, videos, resources, research articles and more at www.honoringchoicesidaho.org/isaidwhatiwant.

If you have already made an advance care plan, help your patients and families realize the value of advance care planning. Tell your family, friends, colleagues, and others on social media why you believe in ACP by using the hashtag #ISaidWhatIWant. Start the conversation today!

Want to learn more about Honoring Choices® Idaho? Contact Stephanie Bender-Kitz, PhD, Project Lead at [email protected], call 208.947.4285, and check out www.honoringchoicesidaho.org.


THE DATESSAVENurse Leaders of Idaho (NLI)/Idaho Alliance of Nurse Leaders (IALN)NLI Board of Directors Meeting, February 20, BoiseIdaho Nursing Workforce Invitational Meeting, February 19, BoiseLegislative Day at the Capitol, February 21, 9AM-12PM, Capitol in BoiseLegislative Conference, February 21, 1PM-4PM, Boise Riverside HotelAmerican Organization of Nurse Executives Annual Conference, April 10-13, San Diego

American Nurses Association Idaho (ANAI)Legislative Day at the Capitol, February 21, 9AM-12PM, Capitol in BoiseLegislative Conference, February 21, 1PM-4PM, Boise Riverside HotelANA Idaho Annual Conference, February 22, 8AM-5PM, Boise Riverside Hotel

Idaho Association of Nurse Anesthetists (IDANA)Pre-Conference Aesthetics Workshop & Spring Anesthesia Conference, April 12-14, Grove Hotel, Boise

Board of NursingSpring Quarterly Meeting, April 26-27, 2019, BoiseSummer Quarterly Meeting, July 11-12, 2019, Boise

Nurse Practitioners of Idaho (NPI)AANP National Health Policy Conference, February 3-5, Washington D.C.AANP Region 10 Invitational Meeting, March 9, Grove Hotel, BoiseAANP Annual Meeting, June 18-23, Indianapolis, IN

Self Care Corner...Be Mindful, Be Present:

Part 1 Katie Roberts, MSN, RNLewis Clark State College

Email: [email protected] The other night as I sat to prepare for

course work, I looked over and noticed my four-year-old sitting on the couch by herself watching a television show. At that moment I realized it was time to put aside my work and spend time with my family. All too often it is easy to bring work home, especially with technology at our finger tips. It is important for our health that we are present in our life at all times.

Often when we think about health and wellness we think of diet and exercise. However, it is important to also ensure that we have healthy minds. Between work, family, school, community activities and other commitments we are involved in, our lives are busy. It is incredibly easy for our minds to be at work when we are at home and at home when we are at work. This can cause our minds and attention to not be where they need to which can lead to mistakes at work. As nurses, it is well known how detrimental those mistakes can be. This lack of mindfulness can also lead our families to feel neglected.

According to Belton (2018), stress at work can lead to poor patient outcomes. Learning to be mindful allows for the ability to process what is happening in the present. To gain mindfulness, there are different skills and workshops for participants to learn mindful-based interventions, which have been proven to help reduce stress and anxiety, ultimately leading to better patient outcomes and decreased nurse burnout and turnover (Belton, 2018). One strategy to achieve healthy mindfulness is to draw yourself to be present. One way to do that is find something that you enjoy: baking, gardening, painting, or spending time with your family. Whatever you choose to participate in, make sure it brings joy and space to allow for debriefing and reflection so that when you care for your patients or family, you can be present and happy.

References:Belton, S. (2018). Caring for the

caregivers: Making the case for mindfulness-based wellness programming to support nurses and prevent staff turnover. Nursing Economics, 36, 191-194.

CONTINUING EDUCATION

Robin Schaeffer, MSN, RN, CAEExecutive Director, Arizona Nurses Association


ANA-Idaho (ANAI) is pleased to announce that we have re-named our continuing nursing education entity to better represent services that are available to every Idaho nurse. The old name, Western Multistate Division has been replaced with Continuing Nursing Education Group (CNEG). CNEG is a partnership between Utah Nurses Association, ANAI and Arizona Nurses Association. There are many excellent nursing-focused educational programs offered in our state, yet some entities have felt intimidated by the complexities of the Continuing Nursing Education (CNE) application process. The good news is that CNEG has improved and streamlined this process! If you would like to apply for CNE contact hours for a single event, program or activity please visit the new website administrated by our Arizona partner www.aznurse.org/CE. You can also access this page through the ANAI website.

All CE is not EqualCNEG is an accredited approver of continuing

nursing education by the American Nurses Credentialing Center’s (ANCC) Commission on Accreditation. ANCC is considered the “gold standard” for CNE and only accredits organizations that demonstrate the use of evidence-based criteria and evaluation.

We Need You….If you like what you have read so far and are looking for

a way to give back to the association/nursing profession, why not consider volunteering as a Nurse Peer Reviewer (NPR)? NPRs are trained as volunteer reviewers for CNE applications. NPRs are the lifeline of CNEG. Criteria for becoming an NPR are listed on the CNEG website www.aznurse.org/CE. CE forms and information are available on the ANAI website at https://idahonurses.nursingnetwork.com/ under “Education & Events”, drop down to “CE Applications”.

Terminology 101: Did you Know?• CEU: Is a retired term no longer in use• Contact Hours: replaced CEUs• CNE: Continuing Nursing Education signifies that

the continuing education (CE) offered is specific for nurses. This is the preferred terminology.

Everything I Need to Know I Did Not Learn in Nursing School!

Being voted the most honest and ethical profession for the last 16 years (Gallup Poll, 2017) suggests public assumption that nurses are professionally competent. The American Nurses Association (ANA, 2014) defines competency as an expected level of performance that integrates knowledge, skills, abilities, and judgment. ANA also states that the registered nurse is individually responsible and accountable for maintaining professional competence. Professional competence goes hand in hand with lifelong learning principles. Here are some of the benefits of CNE:

• Validates specialty knowledge, experience and judgment for Specialty Certification

• Impacts patient care quality/outcomes• Meets some states’ requirement for licensure

renewal (Idaho).• Promotes professional advancement.

The Wisdom of FlorenceLet us never consider ourselves as finished nurses…we

must be learning all of our lives.-Florence Nightingale

References:American Nurses Association (2014). Position Statement:

Professional Role Competence. Retrieved from https://www.nurs ingwor ld.org /pract ice-po l icy/nurs ing-excellence/official-position-statements/id/professional-role-competence/

Gallup (2017). Nurses keep healthy lead as most honest, ethical profession. Retrieved from https://news.gallup.com/poll/224639/nurses-keep-healthy-lead-honest-ethical-profession.aspx

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Success of a Nurse Residency Program in a Critical Access Hospital

By Franci Marks, BSN, RNICU Nurse Manager and Nurse Resident

Manager, Bonner General HealthEmail: [email protected]

Bonner General Health is a critical access hospital located in Sandpoint, Idaho. Due to its location and size, recruitment can be especially difficult. In 2015, the hospital experienced a significant nursing shortage, which prompted the Chief Nursing Officer to look at different opportunities for recruitment and retention of nurses. As a solution, a nurse residency program was initiated, starting with one new nurse graduate. Approximately 18 months into the program, after successfully training four new nurse graduates, the program was re-evaluated and modified to improve the overall experiences of nurse residents while continuing ongoing support to meet the hospital’s needs. Through experience and feedback from the nurse graduates who had completed the program, modifications and adjustments were made to better fit the needs of our hospital and the needs of the nurse residents. The results have been improved job satisfaction and enhanced value of the nurse residents to the nursing departments, while decreasing overall orientation costs. The purpose of this article is to share aspects of instituting and managing a successful nurse residency program from the perspective of a critical access hospital.

Nurse Residency ProgramsHospitals nationwide are facing the challenge of

recruitment and retention of qualified nurses, particularly in specialty areas. The demand for nurses continues to increase as many of the existing nurses from the baby boomer era are reaching retirement age, which adds to the already strained nursing shortage many hospitals are facing (AMN Healthcare, 2018).

One study revealed that turnover rates of newly graduated nurses are roughly 30-40% within the first year of nursing practice, and up to 57% within the second year (Twibell & St. Pierre, 2012).

Successful mentoring and orientation programs, retention of nurses has been shown to decrease turnover rates within the first two years, as well as improve retention (Twibell & St. Pierre, 2012). Helping new nurses get started on the right foot by equipping them with the support they need to develop skills for success and make the transition from student to career as seamless as possible through a nurse residency program is the goal for Bonner General Health. With the help of an in-depth orientation and mentorship program, new graduate nurses develop more confidence and competence, which also helps improve retention. “The

framework of the nurse residency program is evidence-based, and the benefits include reduced turnover, increased engagement of new graduates, improvements in patient safety and satisfaction, acceleration in RN proficiency, and self-confidence” (Fache, 2016). In addition, the Institute of Medicine, the National Council of State Boards of Nursing, and the Commission on Collegiate Nursing Education all advocate for nurse residency programs. Through a prospective study across the United States, a one year nurse residency program shows a retention rate of 87%, along with improved job satisfaction, decreased stress and improved clinical and communication skills of the nursing graduate (Twibell & St. Pierre, 2012). Since the beginning of our nurse residency program in 2015, Bonner General Health has a retention rate of 83% of new graduate nurses within the first year of employment.

Program OverviewBonner General Health has been teamed up to work

in conjunction with the Iowa Online Nurse Residency Program (IONRP). The purpose of this partnership is to develop a nurse residency program with the goal of supporting new nursing graduates to become competent and confident caregivers, as well as reduce the nursing vacancy rate. This is accomplished by providing a focused yearlong clinical training and orientation, while concurrently developing additional skills through online courses provided by the IONRP. Aspects of the online portion of the nurse residency program include a combination of modules, discussions, webinars, surveys, journaling and the completion of an evidence-based project. The online component of the program is designed to help develop some of the non-clinical skills of nursing. The nurses connect with other residents throughout the country online with a live instructor for monthly webinars and modules designed to support nurses in developing greater independence and autonomy with confidence.

The modules and webinars include a variety of topics such as how to deal with legal issues, documentation, communication with physicians, change of shift reporting, student to RN reality shock, compassion fatigue, conflict management, time management and prioritization. The IONRP allows the nurses to learn from their peers as they share experiences, while offering advice and support to one another. At the completion of the IONRP 12-month program, the nurse resident receives a certificate of completion and is awarded 36 contact hours.

Probably the most exciting part of the Nurse Residency program are the clinical orientation opportunities available to the new nurses. The nurses have the opportunity to rotate through all of the major nursing departments throughout

the hospital before receiving a more focused orientation. The nurses are given a familiarization tour of the nursing departments, which includes Medical/Surgical, Post-partum, Labor & Delivery, Surgical Services, Intensive Care Unit, and the Emergency Department. The nurse resident will spend two weeks in each department with the goal of obtaining an overall appreciation and awareness for what that department entails and how the department interrelates with other areas of the hospital. They also develop a basic understanding of the acuity and types of patients that department cares for, how the nursing workload is divided, and what may be expected for a nurse to work in that unit. It is also an opportunity to get to know the culture of the department, and whether or not it is a good fit from a social perspective.

During this 10-week familiarization period, the nurses work alongside a preceptor and perform nursing duties within their scope of practice and level of experience. It is not an all-inclusive orientation, and the nurse is not expected to be able to function as a fully trained staff during this phase. This is not a “shadowing” experience, but rather one in which the nurse can begin to grow in any capacity available, such as developing relationships and rapport with other hospital staff members and gaining an understanding of the interdepartmental associations and interactions.

Track OrientationFollowing the departmental familiarization orientation

period, the nurse resident selects a nursing department of their own interest to receive a more comprehensive orientation. At Bonner General Health, three separate “TRACK” options were developed in which the nurse resident can choose to specialize. In order to meet the staffing challenges within a critical access hospital, the TRACKs include dual department employment. The TRACKS and specialties are:

• Med/Surg and Post-Partum, with the option to specialize in Labor and Delivery

• Same Day Surgery/Post-Operative Care, or specialize in the Operating Room as a surgical nurse

• Critical Care and the Emergency Department

Each TRACK will include specialty classes and certifications, in addition to BLS and ACLS, as required for their area. For example, nurses choosing the critical care and emergency department TRACK go through stroke training, moderate sedation, rhythm interpretation, critical care basics classes, and Trauma Nursing Core Course (TNCC).

FEATURE

Success of a Nurse Residency Program in a Critical Access Hospital continued on page 6

mailto:michelle.beasley%40fdihb.org?subject=

http://fdihb.org

http://portneuf.org


Orientation TRACKs were developed in cooperation with the departmental nurse managers. Their input helped to establish specific time frames required in each area, and which classes and certifications are required to fully develop proficiency in their department. In most areas, a comprehensive orientation will be completed in approximately eight months, including classes and clinical training. At the completion of the clinical phase of orientation, the nurse resident is eligible to apply for a full-time position opening.

During the second half of the online course, they are required to complete a nursing improvement project. The project is something the resident sees as an opportunity for improvement in the nursing departments, or hospital wide, using best evidence-based practices. Once their project has been approved, a mentor coaches the nurse with their project. It is through research of best practice, current policies and protocols, and with some ingenuity of their own, that new ideas have been put into practice. One example of a nurse residency improvement project was the development of a nurse tracking tool and the utilization of the current protocol for documentation and tracking of central line care.

BarriersBarriers in the beginning of the nurse residency program

included requiring nurse residents to complete a full orientation in every nursing department of the hospital.

The full orientation was disruptive and prolonged their overall orientation time. With the introduction of the TRACK system, the nurse residents are happy with their residency orientation experiences, and especially appreciate being able to choose where they will specialize to receive a focused orientation in that area.

Another barrier was getting buy-in from nurse leaders, including departmental managers. Their main concern was the financial burden of orienting new nurses, who may or may not return to their department to work in the future. However, floating and filling in staffing holes showed a significant cost savings over having to pay overtime or hire a traveler. Essentially, orienting the nurses to the various departments ended up saving the departments money in the long run. Within the first two years of the nurse residency program, the nurses filled staffing holes for a total of 3,991.5 hours. In comparison, the difference in savings of utilizing a nurse resident over a traveler was $156,107 and $88,931 over paying another nurse overtime.

ConclusionThe nurse residency program was designed not only

to create a smooth transition from student to career in the new graduate nurse, but also to instill confidence and competence when entering the clinical setting. Job satisfaction has an enormous impact on staff. When a nurse feels welcome, valued, has support, and feels a part of the organization, he or she is more likely to maintain a long-term relationship with their employer (Land, McCurdy, Scott, Baas, & Clark, 2013). Studies have shown due to the high turnover rate of employment within the first year for new

graduate nurses, the estimated financial loss is $40,000 per person (Hofler, 2016). When interviewing new graduate nurses, it was discovered that the nurse residency program is very desirable for new nurse graduates. When asked why students applied to Bonner General Health, time after time the response has been the same: “For the residency program and all the opportunities it provides for new graduate nurses.”

ReferencesAMN Healthcare (2018). Baby boomer nurse retirement

wave hits, magnifying nurse shortages for the next decade. Retrieved from https://www.amnhealthcare.com/latest-healthcare-news/nurse-retirement-wave-hits/

Hofler, L. (2016). Transition of new graduate nurses to the workforce: Challenges and solutions in the changing health care environment. North Carolina Medical Journal, 77(2), 133-136. doi: 10.18043/ncm.77.2.133

Land, K., McCurdy, H., Scott, W., Baas, B., & Clark, L. (2013). Effects of New Graduate RN Residency Programs on Job Satisfaction and Retention Rates. Retrieved from: https://www.researchgate.net/publication/259105337_Effects_of_New_Graduate_RN_Residency_Programs_on_Job_Satisfaction_and_Retention_Rates_A_Literature_Review

The University of Iowa School of Nursing. (2018). Iowa Online Nurse Residency Program. Retrieved from: https://uiowa.edu/ionrp/

Twibell, R., & St. Pierre, J. (2012). Tripping over the welcome mat: Why new nurses don’t stay and what the evidence says we can do about it. American Nurse Today, 7(6), 3.

ADVOCACY IN ACTION

By Michael McGrane, MSN, RNANA Idaho/NLI Lobbyist


The 2019 Idaho Legislature has been in session since Monday, January 7th when our new Governor, Brad Little, delivered the State-of-the-State address. Approximately 25% of the legislators are new this year. They began with orientation meetings early in December, along with leadership elections, committee assignments and several sponsored events to introduce members, new and old, to the issues and agendas pushed by various associations and groups.

Top of the list this year will be healthcare and the successful voter initiative to “Close the Gap” by extending Medicaid to those working adults who previously would not qualify for Medicaid coverage or who earn too little to receive support to purchase health insurance on the Idaho Exchange. Traditionally, this issue has been a tug-of-war between conservative legislators who oppose entitlement programs and resist federal intrusion into state affairs, and those who recognize the extraordinary cost of healthcare and insurance and the desperate consequences faced by those making too little to afford needed care. By now there are likely to have been many attempts to forestall the voter initiative, restrict state funding, add additional requirements to qualify for Medicaid, or otherwise inhibit implementing what 60% of Idaho voters approved in November. This issue may carry through the entire legislative session.

As the legislature convenes in January, the initial work is to review new Administrative Rules. In Idaho, all new rules proposed by the Governor, State Departments and Agencies, and Professional Boards, such as the Board of Nursing, must be adopted by the Legislature before becoming effective.

The Board of Nursing proposed three rule changes: • To revise the definition of “nurse apprentice” to allow

recent nursing graduates to work in a non-licensed capacity;

• Remove obsolete language regarding multistate licensure as a result of Idaho’s; acceptance of the enhanced nurse license interstate compact, and

• Simplify language regarding prescriptions written by advanced practice registered nurses (APRNs).

Once all the new administrative rules are reviewed, House Representatives and Senators begin introducing legislation. There are deadlines for introduction and extended deadlines for Senate and House leadership. Over the session, hundreds of bills are heard, but only a fraction make it through a convoluted process to be signed into law by the Governor. Healthcare bills originate in the House and Senate Health and Welfare Committees. Representative Dr. Fred Wood (R-Burley) is chairman of the House Health and Welfare Committee and Senator Lee Heider (R-Twin Falls) is chairman of the Senate Health and Welfare Committee.

During “Nurses Day at the Capitol” (see below for more information), there will be an opportunity to sit in on the House Health and Welfare Committee hearing, observe the process, and even testify if desired. This is a great opportunity for nurses to interact with legislators, provide professional expertise and influence laws that affect access and delivery of healthcare. The legislative session generally runs into the last week of March or early April.

In addition to the Board of Nursing rules, other issues to watch:

• An effort to extend pay parity to Nurse Practitioners (NPs) who provide the same level of care as physicians for specific procedures;

• The addition of NPs to the list of those protected from discovery for medical peer review activities;

• Reconsideration of the law that allows prosecutors to charge those who attack healthcare workers with a felony in addition to other criminal charges;

• Bills to help address the opioid crisis;

• Extension and funding for suicide prevention and mental health coverage;

• Childhood immunization requirements, and

• Efforts to modify the religious exemption to Idaho’s child welfare law to protect children facing life threatening illnesses.

Nursing is the most highly regarded profession. Thursday, February 21st is your opportunity, along with many other nurses, to become involved and visit with your representatives in the legislature about issues important to nursing.

2019 Nurses Day at the Idaho State Capitol Agenda• 0700-0900 Informal meetings with Senators and

Representatives

• 0900-1100 ANA Idaho/NLI Booth, House Committee Meetings, 1st Floor Rotunda

• 1100-1200 House and Senate floor recognition

Success of a Nurse Residency Program in a Critical Access Hospital continued from page 5

2019 Idaho Legislative Session

We all have a role to play in preparing Idaho for the challenges of responding to a public health emergency or natural disaster. Please share your nursing skills by registering with the Medical Reserve Corps in your area. Training is free.

Join us today!

www.volunteeridaho.org

CMH is accepting applications for a full-time QUAD RN.

This position prefers an RN with clinical experience with an emphasis in quality and a current CPHC certification (or

obtained within one (1) year of hire date).

The applicant will work within utilization review and regulatory compliance as well as conduct documentation review and

lead quality-based initiatives within the facility.

This position is forty (40) hours/wk, Monday-Friday.

On call is not required, however applicant needs to be available by phone to answer job related questions when necessary.

Applications can be printed at CMHLC.ORG.Fax - 208.547.2913 | Phone - 208.547.2760

Quality, Utilization Review, and Clinical Documentation Improvement

QUAD RN


The Evolving Landscape of Non-Cancer Opioid Prescribing: Risk Mitigation as a Baseline

Melanie Nash, DNP, APRNPresident, Nurse Practitioners of Idaho


Opioids have a bad reputation and with good reason. The Centers for Disease Control (CDC) 2017 data showed 68% of the 72,287 drug related deaths in the U.S. were attributed to opioid overdose (Ahmad, Sutton, Spencer, Warner, & Sutton, 2018; CDC, 2018). We have all been touched by this modern epidemic. Despite a ten-year decline in national opioid prescribing, in 2017, Idahoans received 64.1-82.8 opioid prescriptions per 100 persons. Health care providers, both RNs and APRNs, are on the forefront of the battle to treat pain, minimize suffering and mitigate opioid risk for our clients, clinics, and communities. The purpose of this article is to present strategies for safer opioid prescribing to patients with non-cancer pain.

Mitigating Opioid Prescribing RiskRisk mitigation includes strategies and tools employed to identify clients at risk for opioid

misuse, abuse, addiction and overdose (Chaudhary & Compton, 2017). Risk mitigation practices provide a roadmap for safer opioid prescribing and set protective mechanisms in place for the patient, the public and the health care team (Minegishi, Garrido, Pizer, & Frakt, 2017).

The risk mitigation toolbox, discussed in further detail below, is filled with a growing selection of options. Today, APRNs are educated to use multiple tools to assess and monitor opioid effectiveness, assess a patient’s risk for misuse, abuse, diversion, and addiction, and provide patients with education on risk, tolerance and dependence.

Pain ContractsPain contracts are most often used in prescribing opioids for chronic pain. The term

“contract” is misleading, as pain contracts are not legally binding (Chaudhary & Compton, 2017). In my practice, I use the term “informed consent” for opioid pain medication instead of pain contract. Pain contracts provide information on medication side-effects, such as dependence, constipation, reduced gonadotropin production, diminished immune response, reduced cognition, and the development of tolerance, and describe the provider’s responsibility in prescribing, monitoring use, and reordering. Furthermore, these contracts stipulate the provider’s expectation and response for requests for early refills, lost medication, urine toxicology screening, and State Board of Pharmacy scheduled medication data reviews. The client agrees to accept responsibility for use, home management of the medication, and to use the opioid medication for the prescribed condition.

UTOXUrine toxicology (UTOX) testing is an essential tool used to monitor prescribed

medication use, or not-use, and co-substance use (Ahmad et al., 2018). A negative drug screen may signal diversion of the prescribed medication. Be aware, however, that a negative drug screen may occur in the client with minimally prescribed doses. For example, a random urine drug screen might fail to detect irregular use if the dose is too low or the patient takes his entire prescription in the first two weeks of a monthly allotment, but then is tested at the end of the month. An important caveat is for the provider to know the sensitivity and specificity of the urine drug screening test and for what substances it tests. Designer drugs like Kratom and Bath Salts are not discoverable per urine drug screens (D. Bankhead, personal communication, November 2018; Ahmad et al., 2018).

State Prescription Monitoring ProgramsState Prescription Monitoring Programs, through the State Board of Pharmacies, have

expanded to all 50 states, Guam, Puerto Rico, and the District of Columbia. Licensed registered providers must register with the Board of Pharmacy to access this database. Interstate interoperability, and interstate drug monitoring compacts, are a new and evolving tool to monitor multistate prescriptions (Sacco & Sarata, 2018). For example, I currently have access to seven additional states, most of which are contiguous, or close to Idaho.

Abuse Deterrent FormulationsAbuse Deterrent Formulations are physical and/or chemical alterations that resist

tampering. The goal is to block unintended administration through modalities such as chewing, snorting, smoking, and intravenous (IV) use (Litman, Pagan, & Ciceero, 2018). Furthermore, costs are high and many insurances will not preauthorize or reimburse for prescriptions.

Risk Assessment ToolsSpecific Risk Assessment Tools are formal screening tools used to gauge the risk of

opioid use and dependence (dela Cruz & Trivedi, 2015). For example, the Stratification Tool for Opioid Risk Management (STORM), the Current Opioid Misuse Measure (COMM), the Screener and Opioid Assessments for People in Pain (SOAPP), and the SOAPP-R show reliability (Menigishi et al., 2017). Their utility is limited by the time involved to administer the testing and the transferability between patient populations (dela Cruz & Trivedi, 2015, Meltzer E. R., 2009).

Use of NarcanNarcan is an essential tool to combat opioid overdose and death. Narcan (Naloxone)

should be prescribed to all patients on chronic opioids. Chronic opioid patients and their significant others/family need education on the signs of overdose and administration of Narcan (Kelly, Falleh-Sohy, Christello, & Bergman, 2017).

Melanie Nash

The Evolving Landscape of Non-Cancer Opioid Prescribing continued on page 14

Project ECHO Comes to IdahoStacey St.Amand and Lachelle Smith

Idaho Department of Health and WelfareEmail: [email protected]

A unique collaboration among the Idaho Department of Health and Welfare, the University of Idaho, and Washington, Wyoming, Alaska, Montana, Idaho (WWAMI) Medical Education Program brought a state-of-the-art healthcare program to Idaho this year.

Developed by the University of New Mexico Health Sciences Center, Project ECHO (Extension for Community Healthcare Outcomes) was created to deliver medical education and care management to primary care practitioners in remote, medically underserved communities. Delivered through a telehealth model, its goal is to help alleviate practitioner shortages by providing specialty diagnosis and treatment knowledge to practitioners right in their own communities.

Project ECHO started in 2003 as an attempt to help doctors in rural New Mexico treat a widespread outbreak of hepatitis C. By 2006 primary care providers in the state were acquiring new skills to treat mental health disorders, substance abuse, gestational diabetes, and rheumatologic diseases. It has now evolved into an ongoing, globally-recognized program that brings rural practitioners and disease specialists together online to share knowledge and increase treatment capacity of complex conditions. The goal is to use existing resources to provide the same access to care and quality of treatment in rural areas as patients receive in urban areas.

The Hub and Spoke ModelThe ECHO model™ has transformed medical education to increase workforce capacity

by linking specialists – operating as “hubs” – with primary care physicians, nurses, and other clinicians in rural communities – the “spokes.” They participate in virtual teleECHO™ clinics that are supported by teleconferencing technology. During the clinics, practitioners present cases to each other and to the specialists who act as mentors and colleagues, sharing their expertise. The model enables the provision of best-practice care to patients right where they live. Project ECHO has now replicated its program, operating more than 120 hubs for at least 60 diseases in 23 countries.

ECHO IdahoHere in Idaho, with support from the Idaho Department of Health and Welfare’s

Statewide Healthcare Innovation Plan (SHIP), ECHO Idaho’s first virtual teleECHO clinic was launched in March 2018. Focusing on Opioid Addiction and Treatment, the clinics offer

a discussion of best practices from the specialist panel that includes an: MD Pain Specialist, NP, PharmD, MD Addiction Specialist, MD Physiatrist, and LCSW. During sessions, everyone teaches and everyone learns as community providers learn from specialists and from each other, and specialists learn from providers as best practices emerge.

A second clinic began in September focusing on Behavioral Health in Primary Care. ECHO Idaho is also exploring opportunities for delivering medication-assisted treatment (MAT) education to physicians, nurse practitioners, and physician assistants.

Enrollment in ECHO clinics is free and each ECHO clinic is designated for a maximum of 1.0 AMA PRA Category 1 Credit™.

To learn more about ECHO Idaho visit: www.uidaho.edu/echo, email: [email protected], or call 208-364-4698. ECHO Idaho is led by the University of Idaho and WWAMI and is supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services.

FEATURE

http://www.lcsc.edu/nursing


NURSING RECOGNITIONS

The November edition of RN Idaho highlighted nurses recognized at the “Celebrate Nursing Dinner” on September 13, 2018 held in Boise. This event, hosted by Nurse Leaders of Idaho (NLI), serves to celebrate the accomplishments and efforts of all nurses in Idaho and this year individual organizations were invited to select their own nurse recipients for recognition.

The following nurses were recognized by Saint Alphonsus Regional Medical Center for their notable contributions through Daisy Awards and other organizational recognition.

CELEBRATE

CATEGORY:

“DAISY AWARD RECIPIENTS”

Tracy Goff, RN

Emergency Department, Boise

Kara Abel, RN

Transitional Observation Unit, BoiseNote: This is Kara’s 2nd DAISY Award!

Hannah Lundie, RN General Surgical Unit, Boise

Raul Huerta, RN

Neurosciences, BoiseNote: This is Raul’s 2nd DAISY Award!

Steven Hunt, RN

General Surgical, Boise

Malherbe Desert,RN

Emergency Department, Boise

Scotti Hughes,RN Family Maternity Center, Boise

Laurie Spofford,RN

Rehabilitation, Boise

Sara Keen, RN

Medical Oncology, Boise

Gail Snyder,RN

Saint Alphonsus Medical Group OB/GYN, MulvaneySaint Alphonsus Regional Medical Center, Boise

CATEGORY:

“OTHER RECOGNITIONS”

Misti Leavitt,MSN, RN, Interim Director of Acute Care SARMC

Recognized for her nomination for the highest award given at Saint Alphonsus as a President’s award nominee.

Claire Jones,MSN, RN, Director of Critical Care SARMC

Recognized for her work in establishing the first Idaho Board of Nursing sanctioned Critical Care Residency

Eric Swearingen,RN, Clinical Coordinator SARMC (No Picture)Recognized for his key role in the tragic events of June 30th, 2019, a multi-victim stabbing.

Elizabeth Barber, RN, SAHS Health Alliance (No picture)Recognized for her outstanding work with the Saint Alphonsus Health Alliance complex care management.

LaRee Miller,RN

Elm Clinic, CaldwellSaint Alphonsus Regional Medical Center, BoiseNote: This is LaRee’s 2nd DAISY Award!


Nurse Leaders Peer Group of the Northwest Hospital Alliance Receives the

Idaho Rural Health Heroes Award

by Mary Ann Reuter, Executive Director, IHRAEmail: [email protected]

Tari Yourzek, RN, Chief Nursing Officer at Boundary Community Hospital, received the Rural Health Heroes Award as a part of the Nurse Leaders Peer Group of the Northwest Hospital Alliance. Rural Health Association President Mary Barinaga, MD, presented the award. The Nurse Leaders Peer Group is comprised of the Chief Nursing Officers of alliance hospitals. Tari Yourzek is chairperson for the group.

The Northwest Hospital Alliance includes the rural critical access hospitals, Boundary Community Hospital, Bonner General Health, Benewah Community Hospital and Shoshone Medical Center, that partner with Kootenai Health Medical Center in Coeur d’Alene.

The Nurse Leaders Peer Group was nominated to receive an Idaho Rural Health Heroes award because of the many ways its members work to raise the profession of nursing to its highest level, and because of the Nursing Grand Rounds program that formed from the group’s efforts.

The awards are given a week before National Rural Health Day in Idaho (November 15th this year) to recognize rural health educators, community advocates, healthcare providers and program administrators who demonstrate

outstanding service and dedication to rural communities. The Idaho Rural Health Association (IRHA) is a nonprofit

membership organization that provides leadership on rural health issues through advocacy, communication, education and collaboration. As the recognized voice for rural health issues in Idaho, IRHA offers a forum for health professionals, community members and healthcare organizations to work together to identify and find solutions to rural health problems. The Idaho Alliance of Leaders in Nursing (IALN) is an organizational member of IRHA.

Read the stories of all the 2018 Idaho Rural Health Heroes at www.idahorha.org.

Randall Hudspeth, PhD, MBA, MS, APRN-CNP, FAANP

Executive Director, Idaho Center for Nursing


Kevin McEwan, Chief Nursing Officer of Madison Memorial Hospital in Rexburg, Idaho, has been voted to a three year term on the Board of Directors of the American Organization of Nurse Executives (AONE) beginning in 2019. Kevin is an active member of Nurse Leaders of Idaho (NLI), which is the Idaho affiliate of the AONE. Kevin represents AONE/AHA Region 8, which includes New Mexico, Arizona, Colorado, Utah, Wyoming, Montana and Idaho. AONE provides leadership, professional development, advocacy and research to advance nursing practice and patient care, promote nursing leadership excellence and shape public policy for health care nationwide. Having a national board member from Idaho is an amazing opportunity for our Idaho nursing organizations to influence both the national nursing direction as well as health care policy. If you have areas of interest or concern that need a larger voice, please don’t hesitate to contact Kevin at [email protected].

Kevin McEwan, MSN, RN Voted

to AONE Board of Directors

Lee Ann Hancock, Director of Divisional Marketing & Communications

Lindsay Taylor, College of Nursing Career Path Intern


Anita Smith, Ph.D., is the new dean of Idaho State University’s newly formed College of Nursing. Dr. Smith, who joined ISU in August, oversees programs at the Meridian and Pocatello campuses. Prior to ISU, Dr. Smith worked for the Bureau of Navy Medicine at the Defense Health Headquarters in Falls Church, Virginia, serving with the rank of captain. She previously held academic appointments at the University of South Alabama and Point Loma Nazarene University.

“We are very excited about the incredible experiences and leadership that Dr. Smith brings to ISU,” said Rex Force, ISU vice president for health sciences.

Dr. Smith received her bachelor’s and master’s degrees at the University of Washington and her doctorate from the University of San Diego. She has also held leadership positions with the Veterans Administration. Her diverse nursing background includes several deployments to active military action including Iraq and Afghanistan as well as maternal/child, trauma, school, and post-operative nursing.

“I am thrilled to join the ISU School of Nursing. It is an honor to serve with the faculty and staff who support learning and discovery, access to opportunities in nursing, and most importantly, prepare future nurse leaders who will bring compassionate and innovative care to rural settings,” Smith said.

“Dr. Smith brings a wealth of nursing experience to the dean position at ISU. She has a keen desire to live and work in the western part of the U.S., and ISU is fortunate to have someone with her experience and commitment to nursing and nursing education,” said Nancy Renn, former interim dean for the College of Nursing.

After nearly a decade of planning, the School of Nursing officially became the College of Nursing in July this year. This is a huge step for the faculty, staff, leadership team,

and students at the College of Nursing. The project began in 2009 when the faculty at the School of Nursing (SON) approved a vision statement which would lead them towards College status. The vision developed in 2009 stated: “to be an i n t e r n a t i o n a l l y renowned college of nursing sought out by those who are committed to lifelong inquiry for improving the health

of diverse populations.” The faculty and staff in the SON began work to develop fully functional doctoral programs and a successful trajectory of faculty research.

The faculty set out to accomplish these goals. In 2012, the State Board of Education (SBOE) approved the PhD in Nursing and Doctor of Nursing Practice (DNP) - Family Nurse Practitioner (FNP) programs for the School.

“With the growth of our programs it was time for it to move from the school to the college level. Becoming a College makes ISU the destination site to get a nursing degree,” Renn says. “We are proud to have the only PhD, only DNP - FNP, and the only DNP - Psych-Mental Health Nurse Practitioner (PMHNP) programs in the state.” Renn adds, “Here at the College of Nursing we have worked hard to get where we are today. The community’s support has played an important role in our success. Being a College means different things to different people, but it means progress for everyone in the School of Nursing.”

Anita Smith, PhD, RN

New Dean for the New College of Nursing at Idaho State University

Dr. Mary Baringa, MD with award recipient, Tari Yourzek, RN

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Advocacy Requires PerseveranceGus Powell, MSN, CRNA

President, IDANAEmail: guspowellcrna@gmail.

com

Since the inception of the Idaho Association of Nurse Anesthetists (IDANA) 63 years ago, the organization has grown and progressed a great deal. Recently, our association has taken strides to improve our infrastructure and

Idaho Association of Nurse Anesthetists (IDANA) Update

strategic planning. One area our Board of Directors focuses on is how we can better advocate for our members and profession. While we have had some wins with advocacy, the reality is that we are in a marathon, not a sprint.

According to Merriam-Webster (2018), advocacy is defined as the act or process of supporting a cause or proposal. Advocacy as it relates to nurse anesthetists in Idaho can occur in almost every setting and with very diverse audiences. It can take place in an elevator with a member of the public, in the boardroom with an administrator, or in the Capitol with a legislator. The topics change over time, but it is our responsibility as advanced practice nurses (APRNs) to

advocate for our profession and our patients. We can’t assume that advocacy is only done by people in certain positions with specific titles. IDANA is no different than many other professional organizations. We are heavily dependent upon volunteers to do the work of the association, which includes running for office and board positions, as well as sitting on various committees. While these volunteers carry out the formal business and day-to-day practice of the association, all CRNAs have opportunities to advocate, which exponentially increases our professional footprint and impact around the state.

Our focus as CRNAs and APRNs should consist of looking for new and creative ways to advocate and highlight our profession. This includes clinical and non-clinical partnerships. Often, we have situations where we face resistance and our goal seems distant, but it’s necessary to strive to maintain a positive attitude and offer solutions. Advocacy should not be a primarily reactive approach. Instead, advocacy should be proactive and assertive. New areas and relationships continually need to be explored.

As an example of our advocacy efforts, IDANA has partnered with the Society for Opioid Free Anesthesia (SOFA) to increase awareness and resources regarding how we as anesthesia professionals can adapt to the current opioid crisis in our country. SOFA is a nonprofit organization with a goal to research, promote & educate anesthesia professionals and the general public on opioid free pain management techniques. They focus on promoting various anesthesia techniques with limited or no opioids.

With our partnership, each member of IDANA received a year-long membership to SOFA, available at www.goopioidfree.com. This allows our members access to their database of research, information, and practical guides to practice. This commitment also includes hosting speakers at our educational conferences that discuss various ways to minimize opioids in our anesthetics and pain management practices, including lectures on maximizing the use of ultrasound guided nerve blocks and highlighting different enhanced recovery after surgery (ERAS) protocols. Although this single approach will not put an end to the opioid crisis in Idaho, we know it will increase awareness and information sharing in our profession.

Finally, please mark your calendars for some important upcoming dates. IDANA is excited to be hosting our 2nd annual legislative reception on January 24th, followed by a day at the Capitol on January 25th. Also, our annual IDANA Spring meeting will be held in Boise on April 12th-14th at the Grove Hotel. We are excited to see advocacy in action at these upcoming events!

Reference:Merriam-Webster (2018). Advocacy. Retrieved from https://www.

merriamwebster.com/dictionary/advocacy?src=search-dict-box www.honoringchoicesidaho.org.

Please call Human Resources for questions or more information at 541-575-3820

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Human Simulation Lab at Idaho State

UniversityLee Ann Hancock, Director of Divisional

Marketing & Communications Lindsay Taylor, College of

Nursing Career Path InternEmail: [email protected]

Faculty and leadership in the College of Nursing at Idaho State University find it very important that the nursing students get the best possible education and training. When the nursing students are going through training, they work with each other, instructors, and high-fidelity manikins in the Human Simulation lab to learn their skills.

The fourteen high-fidelity manikins are called Meti men and they allow students to identify a pulse, heart, lung and bowel sounds. Their eyes can dilate or constrict according to the light, they can blink, and there is a microphone in them so an instructor can respond to the nursing students’ questions. Meti men help provide real life situations that allow the students to gain experience before they go out into a hospital, nursing home, or a doctor’s office. Chris Smout, the simulation lab coordinator says, “I’m a nurse and I came from the ICU and there isn’t anything I haven’t been able to do on a patient in the ICU that I wasn’t able to do on these Meti men, so it allows us a lot of liberty with what we do with our simulators.”

Before these students can go out into clinical settings, they have to learn their assessments by working with each other and some of the manikins that are low fidelity. Once they have learned all of their skills, they can start doing simulations on the Meti men to get a more real life situation. Before the students can start their clinicals, they have to go through several different tests to check their knowledge and understanding of their skills. The lab allows the students to perfect their skills in a safe environment.

“When they are first starting the program, they are practicing on each other, so we can give them the basic skills and let them practice it in a safe environment. Then as they get a little further on, we throw in simulators using our high-fidelity manikins. Occasionally, they will bring in a standardized patient which is someone they don’t know, and they will pretend to be their patient. This is mostly with the Doctorate of Nursing Practice program not the undergraduate programs,” said Smout.

In the lab, they are always working on refining their simulations to provide the best experience for the student nurses. Smout is always working to make the lab run more effectively, and efficiently. The lab is constantly buying new equipment to stay up-to-date with the surrounding hospitals to make sure the students are getting exposure to anything they could possibly encounter. Some of the equipment they have includes a medication cart, which is what they use in almost every healthcare setting, and an electronic charting system so the students can become more familiarized with how to chart correctly. There are also task trainers such as IV arms or tracheostomy models that allow students to perform specific tasks multiple times. The university just purchased a new Zoll defibrillator as well.

The simulation lab allows the students to learn their skills in a safe but realistic environment. Being able to learn these skills before going into a real-world setting helps the students be more prepared and know how to properly assess their patients. “It made me super nervous to have to do the simulations, but I learned a lot from them. I liked the sims because it makes you critically think and then take action,” said Kenzie Swafford, a graduate from the Bachelors of Nursing program. There are many different situations and settings they can run with these simulations such as being in the emergency room, a doctor’s office or on a medical-surgical floor. The simulation lab is an important part of the learning experience for undergraduate and graduate nursing students.

Students Shine at Lewis-Clark State College Nursing Symposium

By Sydney Parker, MSN, RNC-OBAssistant Professor, Lewis-Clark State College


On December 6, 2018, 50 senior nursing students at Lewis-Clark State College in Lewiston, ID had the opportunity to share evidence-based practice (EBP) projects with faculty, students, and clinical agency representatives at the Fall Nursing Symposium. Projects ranged from best pain management practices in the emergency department to stroke recognition and education in the community. Students shared their projects in conference-style presentations, complete with posters and a “Question and Answer” session.

The EBP projects were a culmination of two semesters of work in collaboration with their Community Health

Pictured (left to right): LCSC nursing students Monica Montero, Shannon Bay, and Virginia Ixta present their EBP project at the Fall Nursing Symposium.

Pictured (left to right): LCSC senior nursing students Julia Platt, Hannah DeLay, and Johanna Ponce answer faculty and student questions at the Question and Answer session following Symposium.

course. In addition to the traditional EBP process, students also had the opportunity to submit self-designed surveys to the Institutional Review Board (IRB) and to design interventions based on survey results, which they shared during Symposium. Students report that they hope to further disseminate their projects following graduation and to eventually implement their interventions with key stakeholder support. “We hope that students will understand not only the process, but also the importance of evidence-based practice and their role in it as a BSN-prepared nurse in the workplace,” stated Sydney Parker, their lead course instructor.

The next cohort of students have begun preparations for their EBP projects and will present at the all campus Symposium on May 2nd at Lewis-Clark State College. All those interested in observing the presentations are invited to attend.

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RN Idaho is pleased to honor deceased registered nurses and licensed practical nurses who graduated from Idaho nursing programs and/or served in Idaho during their nursing careers. Included, when known from a published obituary or when space allows, will be the date when deceased and the Idaho nursing program.

The names will be submitted to the American Nurses Association for inclusion in memoriam held in conjunction with the ANA House of Delegates. Please enable the list’s inclusiveness by submitting information to [email protected].

Bowman, Rodonna, 1924-2018. She attended LPN training in Idaho Falls and worked at LDS Hospital in Idaho Falls.

Brower, Randall Mark, 1950-2018. He was tender-hearted and worked hard to provide for his family. He was a nurse by profession, caring for many.

Carlson, Mary Troy, 1937-2018. She earned her LPN degree from VoTech and worked in the newborn nursery at Madison Memorial Hospital, where she cared for many of her grandchildren during their first hours of life. She finished her career in Central Sterile Processing.

Chadwick, Karin Marie, 1955-2018. Karin attended UC Davis and Idaho State University. She received a Master’s degree and was a very competent nurse in the Emergency Department at Pocatello Regional, where she became Director of Nursing.

Childers, Linda Jane, 1947-2018. Linda attended Boise State College where she earned her Associate Degree in Nursing in 1969. Linda worked at Mercy Medical Center from 1969 until she retired in 2007. She was involved in over 10,000 births in her 38 year career. To honor her dedication, Saint Alphonsus in Nampa dedicated a birthing room in her name in and they refer to it as a “womb with a view,” as it overlooks the Centennial Golf Course.

Clark, Paula Marie Ritzman, 1939-2018. Paula was born in Pocatello and attended Holy Cross Nursing School in Salt Lake City. She worked at St. Anthony’s Hospital, Pocatello, and went on to work as a nurse in Utah, Tennessee, and California.

Eisenbeis, Debra Rose, 1955-2018. Debi graduated from the LPN program at Boise State University. She worked as a nurse in a wide variety of medical settings for more than 30 years.

Felde, Jeffery James, 1978-2018. Jeff served in the United States Air Force in the 68th Unit from 2002 to 2008. He proudly served in both Operation Iraqi Freedom and Enduring Freedom. After honorably discharging as a Staff Sergeant, he attended Idaho State University where he received his BSN. He worked as an RN for Heritage Home Health in Pocatello. The care and compassion he had for his patients was tireless, and he was adored by them in return.

Gaertner, Carol, 1938-2018. She was a professional model for the Crescent Stores in Spokane before finding her life’s calling as a

nurse. She retired from Saint Alphonsus in Boise in 2008.

Galarza, Marjorie, 1924-2018. Marjorie graduated from Boise Junior College School of Nursing in 1962. She later worked for Mercy, St. Alphonsus, St. Luke’s, and Caldwell Memorial Hospitals.

Gordy, Frances, 1920-2018. Frances became an LPN at the Caldwell Memorial Hospital. She enjoyed many proud years as an OB nurse and helped countless lives in the nursery. Even in retirement, she continued caring for others in home health and volunteer work.

Hugg, Dorothy Ann Fackler, 1940-2018. She received her LPN degree from St. Luke’s Hospital School of Nursing and Boise Junior College in 1959. She returned to school two more times to receive an Associate RN degree and a BSN at Weber State University. She practiced nursing in Oklahoma, Washington, Utah and Idaho in Medical/Surgical, ICU, Endoscopy, and Home Nursing for years.

Kersey, Dorothy Alice, 1930-2018. Dorothy worked at the old St. Alphonsus Hospital in downtown Boise. She later helped open Boise Convalescent Center as Director of Nursing, and also worked at Grand Oaks Nursing Home as Director of Nursing. She then joined the Boise School District, teaching Health Occupations. Dorothy then spent 12 years with the Meridian School District as a school nurse.

Langford-Vance, Lillie Marie, 1938-2018. She returned to school after her family was raised, obtaining her BSN from Boise State University in 1992. She worked in hospitals and elderly care before retiring in 2009.

Macdonald, Mary Louise “Mimi”, 1949-2018. She was a founding leader of the Pocatello chapter of La Leche League International. Her passion for helping mothers and infants continued for almost 20 years in this role. Mimi worked as a nurse, spending the last two decades of her career as a research study coordinator with ISU Family Medicine.

Pahl, Frieda Justina, 1936-2018. She attended school in American Falls and furthered her education at St. Anthony’s Hospital, where she became an RN in 1958. She worked at St. Anthony’s Hospital in Pocatello and Power County Hospital in American Falls.

Pecher, Thelma May, 1929-2018. Thelma was born in Twin Falls. She graduated from Kimberly High School in 1947 and the College of Southern Idaho in 1972 from the LPN program.

Ray, Carolyn, 1930-2018. She achieved the Practical Nurse Training Certificate from Idaho State University LPN Program and St. Anthony Community Hospital in 1969. She was a charge nurse while employed at Bannock Nursing Home. Education was so important to her that she encouraged and provided opportunities for coworkers to obtain their career goals as well.

Ray, Laura Mary Mathews, 1930-2018. She attended nursing school at Riverview Hospital in Idaho Falls. Her skills as a nurse were highly respected and she was sought after for her gifts

to the nursing field. She was selected to start up the Intensive Care Unit as well as the Nursery Intensive Care Unit at Parkview and Riverview Hospitals.

Reeves, Julia Lee, 1934-2018. Julia graduated in 1953 from St. Luke’s Hospital and worked in hospitals around the Treasure Valley, including Mercy Hospital and the Idaho State School and Hospital.

Smith, Ada Kathryn Jones, 1926-2018. She graduated from Ricks College with an Associate Degree in nursing. She spent many years working at the Caribou Memorial Hospital in Soda Springs. In 1970, she returned to Idaho State University and obtained her BSN.

Smith, Ellen Myrdean Roseborough, 1933-2018. Myrdean spent most of her career working as a nurse at Ashton Hospital, Madison Memorial Hospital, and District 7 Health office.

Stewart, Opal Waive Turnidge Clapp, 1927-2018. Opal graduated from St. Luke’s Hospital School of Nursing. She worked labor and delivery for many years before returning to school at the University of Arkansas to become a Nurse Practitioner. She became one of Idaho’s first Certified Registered Nurse Practitioners.

Stokes, Katheryne, 1921-2018. She became an LPN in 1962, retiring after 20 years in 1983.

Tuller, Anna Jean, 1925-2018. Jean graduated from St. Luke’s Hospital School of Nursing in 1948. After her husband graduated, they returned to Boise where she worked as a surgery and obstetrics nurse at St. Luke’s Hospital. Later, Jean worked at Saint Alphonsus Hospital as a float nurse.

VanLeuven, JoAnne, 1940-2018. JoAnne went to Ricks College and Carroll College to obtain her RN license. Later, she attended Idaho State University and received a BSN. She worked at Bannock Hospital in Pocatello for many years as a cancer nurse and retired in 2002.

Warner, Margaret Wilmoth Reay, 1940-2018. She graduated from Idaho State College with her certificate in practical nursing. She worked as an LPN for the remainder of her life.

Wells, Doreen Alleman Hibbert, 1926-2018. Doreen attended the nursing program at the LDS Hospital in Idaho Falls through the Cadet Nursing Program during WWII. Afterwards she received her pediatric nursing training in Springfield, Illinois. She worked for 23 years as pediatric night nurse at Bannock Memorial Hospital in Pocatello.

Whiting, Jon Myrtle Innes, 1937-2018. After her family was raised, she enrolled in the LPN program at St. Anthony’s Hospital. She worked exceptionally hard to earn the right to wear her nurse’s cap and did so proudly. Her nursing career spanned more than 30 years.

Zohner, Marivene Amelia List, 1953-2018. She enjoyed her work as a nurse, focused in the Neonatal ICU in multiple locations including Idaho Falls, and Provo and Orem, Utah.


Sandra Evans, Executive DirectorIdaho Board of Nursing


The Idaho Board of Nursing continuously strives to remain relevant by a sustained awareness of and responsiveness to changes in the healthcare and regulatory environments. To this end, each quarter Board members identify and discuss current state, national and global issues and evolving trends that do or may in the future impact the work of the Idaho Board. These ongoing generative conversations assist the Board in knowing what’s coming our way and the impact these trends may have on the regulation of nursing practice and education in Idaho, the U.S. and around the world.

At their meeting on November 1-2, 2018, the Board identified the following issues/trends of significance:

UPDATE FROM THE BOARD OF NURSING

In addition to the above, the Board accomplished new and continuing routine business related to their primary strategic goals at their November 2018 meeting. Board members Vicki Allen, RN, Pocatello, Chair; Carrie Nutsch, LPN, Jerome, Vice Chair; Jennifer Hines-Josephson, RN, Rathdrum; Whitney Hunter, Consumer, Boise; Jan Moseley, RN, Coeur d’Alene; Rebecca Reese, LPN, Post Falls; Clay Sanders, APRN, CRNA, Boise; Merrilee Stevenson, RN, Wendell; and Reneé Watson, RN, Boise:

• Reviewed correspondence and reports of external meetings attended by Board members and staff, including the National Council of State Boards of Nursing (NCSBN) 2018 Annual Meeting and Delegate Assembly in Minneapolis, MN August 15-18; the 2018 Citizen Advocacy Center (CAC) Annual Meeting in Washington, DC, October 16-17; meetings of the Nurse Licensure Compact Interstate Commission in Minneapolis, August 14 and by teleconference October 9; 2018 biennial International Nurse Collaborative Symposium in Chicago, October 22-23; and NCSBN Scientific Symposium in Chicago, October 24;

• Reviewed administrative rules proposed at their July 2018 meeting and unanimously adopted them as “pending” for consideration by the 2019 Idaho Legislature. The pending rules, for which no public comments were received during the designated comment period following their initial publication, address:

° Changes in required criteria for APRN prescriptions; and ° Clarification of the approval term for nurse apprentices following graduation from their

nursing education programs;

• Appointed Zach Morarity, MD, Twin Falls and Ralene Wiberg, MD, Boise to three year terms on the Board’s APRN Advisory Committee;

• Appointed Heather Naskar, APRN-CRNA, Middleton; Susie Bunt, RN, Lewiston; Jill Humble, RN, Boise; and Susan “Spooky” Taft, Consumer, Ketchum to three year terms on the Board’s Program for Recovering Nurses (PRN) Advisory Committee;

Goal Initiative Issues/Trends

Licensure

Practice

Education

Communications

• Nationwide bi-partisan political movement toward deregulation of occupations in an effort to reduce barriers to employment

• Support for regulatory options to enhance license portability (e.g. licensure compacts)

• International efforts to address the need for more nurses, including strategies to credential refugee nurses who are unable to access primary source documents due to geopolitical turmoil in their countries of origin

• International support for needs-based designated nurse staffing levels

• Support for use of non-licensed community health workers as a way to reduce hospitalizations and/or emergency room visits

• Guidelines for the use of medical marijuana for patients, care givers, and prescribers that may impact aging practitioners

• Evidence of age-associated cognitive changes and their effects on work performance

• Emerging/evolving practices and increased blurring of roles between professions (e.g. RN prescribing authority in Canada, aesthetic procedures, etc.)

• More nurses pursuing higher levels of education than ever before (e.g. 180% increase in the number of nurses completing RN-to-BSN programs from 2010 to 2017)

• Increased enrollment in Doctor of Nursing Practice programs over previous years

• Legislative movement toward decriminalization of certain crimes for licensure and disciplinary purposes (e.g. decriminalizing misdemeanor crimes unless directly related to nursing practice)

• Substance use disorder among nurses as part of the national opioid abuse epidemic and strategies to support nurses in their return to safe practice

Discipline

• More people worldwide communicating directly on a computer network rather than face-to-face, impacting organizational communication processes

• Ethical issues surrounding communication within organizations as a growing concern (e.g. patient confidentiality violations, right to privacy concerns, employer rights)

• Cybersecurity threats

• Accepted reports and recommendations from the Board’s APRN and PRN Advisory Committees;

• Took formal action to revoke the licenses of two LPNs based on determination of violations of provisions of the Nursing Practice Act and Administrative Rules of the Board;

• Following a contested case hearing before the Board during which arguments on both sides were presented, the Board took action to revoke the RN and APRN, CNP licenses of a nurse based on determination of violations of provisions of the Nursing Practice Act and Administrative Rules of the Board;

• Granted full approval for the eight year period ending 2026 to the practical nursing education program proposed for implementation by the College of Western Idaho; and

• Granted full continuing approval for the eight year period ending 2026 to practical nursing program administered by the College of Technology, Idaho State University.

Meetings of the Board are generally held in Boise at locations to be announced prior to the meeting and include an “Open Forum” on the second morning of each meeting. During the open forum, the public is provided the opportunity to dialogue with the Board on issues of interest that are not necessarily included on the published agenda. The Board will not take action on issues introduced during the forum, but may choose to address them at a later scheduled Board meeting.

As always, the Board welcomes your comments and suggestions and invites the public to attend all or portions of scheduled meetings of the Board. For further information, visit the Board’s website or contact the Board office at 208.577.2476.

http://projectfilter.org

mailto:projectfilter%40dhw.idaho.gov?subject=


The Opioid DiscussionBehavioral health comorbidities such as post-traumatic stress disorder (PTSD), depression, bipolar disorder, and other health conditions correlate with a higher incidence of opioid use disorder (OUD) (Proctor, 2013). Musculoskeletal pain combined with PTSD makes the patient at higher risk for misuse, abuse and addiction (Bilevicius, Sommer, Asmundson, & El-Gabalawy, 2018). The provider should know the chronic pain conditions for which opioids are not the recommended treatment.

Clues to Misuse, Abuse, Tolerance, Dependence, Pseudo-addiction, or AddictionEvaluation for client misuse, abuse, tolerance, dependence, pseudo-addiction, or addiction to opioids is an ongoing component of risk mitigation (Meltzer, Rybin, Saitz, Samet, Schwartz, Butler, & Liebschutz, 2011). Clues include: multiple requests for early refills; reports of lost or stolen medication; request for dose escalation; provider shopping; patients coming from a long distance to your clinic; or bringing older records to corroborate prior opioid prescriptions (Lawrence, Mogford, & Colvin, 2017; Hoffman, 2017). Other clues include: receiving multiple prescriptions from different pharmacies; positive urine drug screening for other substances, or screening not positive for prescribed opioid; or missing follow-up appointments and/or UTOX (Meltzer et al., 2011).

ConclusionIn conclusion, risk mitigation includes establishing

treatment goals with your patient prior to prescribing. A goal should be to use opioids to improve functional capacity, not eradicate pain. Providers need to discuss and reinforce the risks and benefits of therapy. For non-cancer— acute pain—prescribe opioid pain medication for a duration of three days, utilizing immediate-release opioid formulations. For

chronic pain, nonpharmacologic and nonopioid therapies are preferred. If there is no functional improvement within four to six weeks, discontinue therapy (Frieden & Houry, 2016).

Motivational Interviewing Techniques are effective communication tools to explore/acknowledge the patient’s beliefs about their pain experience, including anxiety and fear of pain (S. Pote, personal communication, November 2018). Prescribers should explore the presence or history of previous or current substance use disorders, as well as the chronic use of such substances as alcohol, marijuana, recreational drugs, and the use of non-prescription or borrowed medications.

Pain is a complex entity that is intertwined within the human condition. The experience of pain is individual and laced with social, physical, and psychological co-morbidities and emotional distress. Faithful employment of risk mitigation practices in the prescribing of opioids for non-cancer pain protects the patient, the community and your practice.

ReferencesAhmad, F. B., Sutton, L. M., Spencer, M. R., Warner, M., & Sutton,

P. (2018). Provisional drug overdose counts. Retrieved November 26, 2018, from https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

Bilevicius, E., Sommer, J. L., Asmundson, G. J., & El-Gabalawy, R. (2018). Posttraumatic stress disorder and chronic pain are associated with opioid use disorder: Results from a 2012-2013 American nationally representative survey. Drug and Alcohol Dependence, 188, 119-125.

Centers for Disease Control. (2018) U.S. Opioid Prescribing Rate Maps. Retrieved from https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html

Chaudhary, S., & Compton, P. (2017). Use of risk mitigation practices by family nurse practitioners prescribing opioids for the management of chronic nonmalignant pain. Substance Abuse, 38(1), 95-104. http://dx.doi.org/10.1080/08897077.2016.1265038

dela Cruz, A. M., & Trivedi, M. H. (2015). Opioid addiction screening

The Evolving Landscape of Non-Cancer Opioid Prescribing continued from page 7

Karen Neill, PhD, RN, SANE-A, DF-IAFNPresident, NLI and IALNEmail: [email protected]

The Board of Directors of both Nurse Leaders of Idaho (NLI) and Idaho Alliance of Leaders in Nursing (IALN) are looking forward to another successful year. The year 2018 brought significant changes to both organizations by increasing influence on public policy and the future of nursing in Idaho. With the knowledge that Idaho is facing the largest nursing shortage in its history within the next five years, as well as understanding the impact of recognition in the workplace and support for nursing education on retaining the workforce, the organization’s activities have focused on these opportunities.

Communication is essential and NLI and IALN are determined to continually improve how nurses in Idaho can receive and access information and educational alerts. RN Idaho underwent a big change when the sponsorship was

IALN AND NLI UPDATES

tools for patients with chronic non-cancer pain. Texas Medicine, 111(2), 2-7.

Frieden, T. R., & Houry, D. (2016, April 21). Reducing the risks of relief—the CDC opioid-prescribing guideline. New England Journal of Medicine, 374, 1501-1504. http://dx.doi.org/DOI: 10.1056/NEJMp1515917

Hoffman, M. (2017). Gundersen’s comprehensive approach to opioid prescribing & chronic pain management. H&HN: Hospitals & Health Networks, 91(12), 36-38.

Kelly, J. F., Falleh-Sohy, N., Christello, J., & Bergman, B. (2017). Coping with the enduring unpredictability of opioid addiction: An investigation of a novel family-focused peer support organization. Journal of Substance Abuse Treatment, 77, 193-200. http://dx.doi.org/10.106/j.sat.2017.02.010

Lawrence, R., Mogford, D., & Colvin, L. (2017). Systematic review to determine which validated measurement tools can be used to assess risk of problematic analgesic use in patients with chronic pain. British Journal of Anaesthesia, 119, 1092-1109.

Litman, R. S., Pagan, O. H., & Ciceero, T. J. (2018). Abuse-deterrent opioid formulations. Anesthesiology, 128(5), 1015-1026. http://dx.doi.org/10.1097/ALN0000000000002031

Meltzer, E. C., Rybin, D., Saitz, R., Samet, J. H., Schwartz, S. L., Butler, S. F., & Liebschutz, J. M. (2011). Identifying prescription opioid use disorder in primary care: Diagnostic characteristics of the current opioid misuse measure (COMM). Pain, 152, 397-402. http://dx.doi.org/10.1016/j.pain.2010.11.006

Minegishi, T., Garrido, M. M., Pizer, S. D., & Frakt, A. B. (2017). Effectiveness of policy and risk targeting for opioid related risk mitigation: A randomised programme evaluation with stepped wedge design. British Medical Journal Open, 1-6. http://dx.doi.org/10.1136/bmjopen-2017-020097

Proctor, S. L., Estroff, T. W., Empting, L. D., Shearer-Williams, S., & Hoffman, N. G. (2013). Prevalance of substance use and psychiatric disorders in a highly select chronic pain population. American Society of Addiction Medicine, 7(1), 17-24.

Sacco, L. N., Duff, J. H., & Sarata, A. K. (2018). Prescription drug monitoring programs [Congressional research]. Retrieved from https://fas.org/sgp/crs/misc/R42593.pdf

changed from its long-standing relationship with ANA-Idaho (formerly the Idaho Nurses Association) and moved to IALN and the Idaho Center for Nursing. This move helped maintain the financial viability of the publication and altered its focus to be on all nursing organizations in Idaho and on the importance of nurse recognition in general.

To ease online communications, NLI, IALN, and the Nursing Action Coalition established a new website that is hosted through Nursing Networks. This is the same host that ANA-Idaho, the School Nurses of Idaho, and Nurse Practitioners of Idaho use. The layout and navigation systems are the same, so it is easier for nurses to move between these websites. This allows the association to maintain easy control over posting announcements and events. Similar to RN Idaho, the website can be used by non-members who select to follow organizational activities and connect with partners (see announcement on how to “Follow Your Organization.”)

Program forRecovering Nurses

Addiction Intervention and Recovery Services for Nursing Professionals

Do you know a nurse or a colleague who needs help for drugs/alcohol or mental health problems?

Please contact us for assistance. This program is an alternative to disciplinary action offered by the BON.

For immediate assistance, please call us at 800-386-1695www.southworthassociates.net

NLI and IALN programs also support an educated and sustained nursing workforce. A major contribution to understanding the current nursing workforce issues was the data collection and analysis of the 2018 Nursing Workforce Report. This is a biennial study that is completed in collaboration with the Idaho Board of Nursing, Idaho Hospital Association, Idaho Healthcare Association, Home Health and Hospice, Public Health and all nursing education programs in the state. The data is analyzed by nurses who understand the nuances of the profession and its practice and nursing supply implications. The data is available on the NLI website and has been widely distributed within the state to healthcare institutions, legislators, and education facilities.

Understanding and supporting the recognition of nurses in the workplace is an important aspect of workforce satisfaction. NLI is again planning to host the annual “Nurse Celebration and Recognition Dinner” in conjunction with the Fall 2019 conference. Any healthcare agency that employs nurses and has recognized them for their contributions, is encouraged to participate and have their staff recognized on a statewide basis.

The nursing organizations in Idaho are strong and well-positioned to impact nursing practice within the state. The NLI/IALN Board of Directors looks forward to the continued success of RN Idaho, the nursing educational offerings within the state, and the success of each individual nursing organization as a part of the Idaho Center for Nursing.

http://careers.havenbehavioral.com


American Nurses Association/ ANA Idaho Membership – It’s Your Choice! It’s Your Privilege!

Just Because You Received This Publication, Doesn’t Mean You Are an ANA Idaho Member

http://joinana.org

Contact Jocelyn Lee | [email protected] | (615) 660-6806

Correctional care.Committed Careers.

registered Nurses

LiCeNsed PraCtiCaL Nurses

CorreCtioNaL mediCaL sPeCiaLists

(Throughout the state of Idaho)

Now hiring!

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