Nurse Reporter Winter 2010 - Wyoming State Board of Nursing

Vol. 6NurseNumber 4 Winter 2010R E P O R T E RWyomingIt’s nottoo lateto renewsee page 11PQRST(Practice QuestionsRequiring SubstantialThought)Diet, Exercise and AttitudeHow I Changed My LifeBy Jeannette Hoem

WyomingWinter 2010 Vol. 6 Number 4EditorMary Kay GoetterAssistant EditorPatti GardnerNurse RT a b l e o f C o n t e n t s“Serving and safeguarding thepeople of Wyoming through theregulation of nursing education andpractice”E P O R T E RPublished by theWyoming State Board of Nursing1810 Pioneer Ave.Cheyenne, Wyoming 82002Phone: 307-777-7601Fax: 307-777-3519Web Address: http://nursing.state.wy.usMission: To serve and safeguard the people ofWyoming through the regulation of nursing educationand practice.Vision Statement: The Wyoming State Board ofNursing, acknowledging the dynamic nature of healthcare,provides the climate, collaboration and regulatoryframework for nurses to practice to the fullest extent oftheir scope.Values: Excellence, Ethics, Education, Safety andCompetence.Executive DirectorMary Kay Goetter, PhD, RNC, NEA-BCAssistant Executive Director,Practice and Education ConsultantTodd Berger, MSN, ACNP-BC, ACNS-BCCompliance ConsultantsPatti Hefflin, BSN, RNJames Hibbits, MS, JD, RNFinancial and Human Resources OfficerCindy StillahnExecutive AssistantAmanda RobertsLicensing CoordinatorsMaxine HernandezLaVelle OjedaDisciplinary AssistantDebra BallLegal AssistantJan RossBoard of Nursing MembersKellie Clausen, FNP, WHCNP, RN PresidentTracy Wasserburger, RN-C, APRN, NNP-BCVice PresidentMarguerite HermanConsumer SecretaryLee Carruthers, RN--RNRepresentativeKim Williamson, LPNMemberMarcie Burr, RN, HSA, CCHPMemberCarrie Deselms, APRN, FNP-BC MemberWyoming Nurse Reporter does not necessarilyendorse advertisements contained herein. Thepublisher reserves the right to accept or rejectadvertisements for Wyoming Nurse Reporter.For Advertising Information:Victor Hornevhorne@pcipublishing.com501.221.9986 or 800.561.4686 ext. 114Created By:Publishing Concepts, Inc.Virginia Robertson, Publishervrobertson@pcipublishing.comThinkNurse.comPublishing Concepts, Inc.14109 Taylor Loop RoadLittle Rock, AR 72223EDITION 233 Editorial5 President’s Message7 Wyoming Center for Nursing and Health Care Partnerships Corner8 Practice Questions Requiring Substantial Thought11 Woman Gets Probation for Faking Mental Health License12 Health Care Providers’ Responses toMedical Traumatic Stress in Their Patients14 Getting to Know Wyoming Nurses16 The Truth about Nursing20 Kellie Clausen named winner for the Distinguished Nursing Award20 Did you know you can read the Wyoming Nurse Reporter online?22 In Memoriam22 Member Spotlight23 Norman S. Holt Award23 Member Spotlight24 How I changed my Life25 Customer Service Corner26 Disciplinary Actions30 Pearls of PracticeGreetings From Mary Kay GoetterExecutive DirectorI felt like I was a little bitlate and it was immediatelyapparent that I really waslate. I was walking as fast asI could without actually runningand people were callingout, asking for supplies, everylight was on and the generalfeeling was one of barelycontrolled chaos. It was thesame corridor I had walkedContinued on next pageto the intensive care unitfor all the years I workedthere, but for some reason itseemed noisier, brighter.“Here! Come here! Weneed you!” someone calledto me.“I’m here,” I answeredbreathlessly, “What do youwant me to do? How can Ihelp?”“You’ve got two,” was theresponse.I turned to see my twopatients and barely suppresseda gasp of dismay.One was burned hideously.I could tell she was female,but not much else. I didn’tthink there was anything Icould do for her. However,the one right in front of me,he was not burned at all. Buthe was gasping for breathand I knew that I had to actquickly.“Oxygen!” I called out,to no one in particular, foreveryone was engaged intheir own frantic endeavors.“I need oxygen and a nonrebreathermask!”The oxygen was there, atthe head of the bed where italways was, but there was nomask, not even a cannula,much less the non-rebreatherI knew my patient needed.Wyoming Nurse Reporter 3

say, “You have to do something.” But thequestion becomes, WHAT? What is thesomething we need to do that will relievethe pressure, bring ease and rest, and not beharmful to ourselves or our loved ones? Wedo need stress relief, we need a break fromconstantly putting everyone else’s needsahead of our own. We need to feed ourselvessustaining food and drink fluids to regain ourenergy and strength. We need to take ourbodies out into the sunshine and fresh air forinvigorating exercise. We need to surroundourselves with nurturing friends and familymembers who will listen when we need tospeak and be silent with us when we cannot.We need to take care of the symptomsof unmitigated stress that arise from alwayshaving to take care of someone else FIRST.Here at the WSBN, we see first-hand, everyday, the terrible cost that comes to nursesin pain who turn to alcohol, opiates, stimulants,depressants, and other substancesin search of relief. Once excellent nurseswho become careless and hardened in theirdecision-making. Skilled nurses who areshadowed by untreated mental and physicalhealth issues. Nurses who just lose their wayand cannot find it back. Nurses who needhelp but are afraid to ask. Nurses who wouldrather die—than ask for help.So, I tell you my dream story to share theidea that there are times we all struggle withwhat we have seen, what we have done, andwhat we wish we could have done. There isno shame in admitting that sometimes it isjust overwhelming. As a profession, nurseshave had a tendency to not take self-careneeds seriously, until all too often—it is toolate. I ask you to look in your heart, look inyour soul, look in your mirror, and ask yourselfif you are honoring your own self andyour self-care needs. If you are not, and youdon’t think you can do it by yourself—askfor help. Talk to someone who can listenobjectively, with compassion and insight,and provide options for you to find yourselfwhole and healthy again. I have and it wasthe best decision I could have made.A Message from Kellie ClausenPresident of Wyoming State Board of NursingSelf care is sucha timely subject.Every day I talkto people who areat the end of theirendurance andoverwhelmed withtheir lives. Thesource of theiranxiety is almostalways a perceptionthat they take care of everyone else but haveno time for themselves; that they are somehowundeserving of the care they provide to others.I have to admit that I am a horribleoffender. I worry constantly, I don’t exerciseenough, I don’t eat as well as I should and Ihave few leisure time activities (what leisuretime) and vacations. Do board of nursingmeetings count as vacation time? Yet, if somany people are depending on us, don’t weneed to make a point of taking better care ofourselves? After all, even the president of theUnited States exercises every day!I was recently at a dinner where Mrs. DianaEnzi was the speaker and she addressed “caringfor the caregiver.” She suggested writing a lifelist of 100 things one might do just for oneself;a sort of a “bucket list” if you will. I have spenta lot of time thinking about my list. I won’tplague you with the entire list but some ofthe things we can all do to take better careof ourselves are the obvious—eating better,exercising more frequently, and taking moretime for pleasurable activities. There are alsothe less common things like learning to paintor sculpt, taking music lessons (admittedlyone of mine), or planning a trip to a place thatoffers activities you enjoy, like say horsebackriding? You can fill in the list that applies toyou.As I am writing this article the generalelections have passed and there are manychanges ahead for the Wyoming State Boardof Nursing with a new Governor and hisappointees. I look forward to change but Iwill also greatly miss Governor Fruedenthal.Governor Freudenthal appointed me to theboard of nursing and I will always have asoft spot in my heart for that gift and for histhoughtful leadership of our state. I wouldlike to thank Wendy Curan for all the timeand mentoring she has provided for the boardand for me personally; and Attorney GeneralBruce Salsburg for being an advocate fornursing. Without his support of the boardand his appointment of quality assistantattorney generals we could not have fulfilledour statutory assignment of protection of thepeople of the state of Wyoming.At least two Nurses that I know of, andpossibly more that I don’t know about, wereelected to office in the recent election.CONGRATULATIONS and good job toLeslie Nutting and Connie Jacobson. It is ahuge commitment and risk to put your nameon the line and run for public office and both ofthese stellar nurses ran honorable campaigns.These two nurses represent the voice of us alland I hope they serve as role models for othernurses who might consider running for office.If there are other nurses who were electedplease let me know through the website sothat I can congratulate them too.This will be my last column as president ofthe Wyoming State Board of Nursing. Thankyou for all your support. I will continue toserve on the board as the Advanced PracticeRepresentative for one more year. Therewill be an opening for an LPN this year andthis has traditionally been one of the hardestpositions on our board to fill. If you are anLPN or you know an LPN, I would encourageyou to consider applying. Our beloved KimWilliamson will fulfill her commitment to theboard in February. As the LPN representative,Kim has been the quiet, devoted presence onthe board we could all hope to be. She hasserved tirelessly on the discipline committeewhich is undoubtedly the most difficult andtrying committee of our board. Thank youjust isn’t nearly enough recognition for thisamazing woman. Kim you will be sorelymissed.As you read this article I hope you willthink of at least one thing (if not 100) you cando to care for yourself every day.Kellie Clausen, RN-C, WHCNP-BC, FNPPresident, Wyoming State Board of NursingWyoming Nurse Reporter 5

Success is not adestination, it’s a journey.Zig ZiglarRNs – Join us on ourjourney to success!We have opportunities in:- Med/Surg- PRN/Per DiemAs a partner ofLifePoint Hosptials weare “All About People”.We deliver world classcare close to home.To us,explorationis a way oflife.Discover for yourself why people fallin love with beautiful Lander Valley– Nestled against the foothills of theWind River Mountains on the banksof the Popo Agie River, it is home toblue skies, breath taking scenery andadventure filled days.We seek it, we find it. Groundbreaking accomplishments,medical innovations that improvethe way we care for our patients and dynamic,passionate leaders like you. At CheyenneRegional Medical Center, where growth isongoing, we offer stimulating careers and awarm, friendly environment with opportunitiesto achieve more.• Registered Nurses• Charge Nurses• Advanced Practice Nurses• Clinical Manager, ICULife is good here. Join our family at CRMCtoday. We offer a generous benefi ts and compensationpackage.Contact:Teresa McCarrel, Talent Consultant214 East 23rd Street • Cheyenne, WY 82001Phone: 888-967-5862 or 307-633-7639Email: teresa.mccarrel@crmcwy.orgwww.crmcwy.org/careerEOETo apply, visit our website atwww.landerhospital.comLander Regional Hospital1320 Bishop Randall DriveLander, WY 82520307-335-6580Fax 307-332-3548EOECareers that blend heartscience.6 Wyoming Nurse Reporter© 2010 NAS(Media: delete copyright notice)

The Wyoming Center for Nursing andHealth Care Partnerships CornerThe most wonderful feeling is knowing that there are peoplearound you who support you and are there to help you… The moreencouragement I get, the better I can function as a nurse.The 2010 Nursing Summit, held in conjunction with the WyomingNurses Association and co-sponsored by WNA, the Fay W. WhitneySchool of Nursing and the WCNHCP, focused on the transition ofnew graduates into practice.Highlights of the summit included the keynote address by ElaineScott, Director of the East Carolina Center for Nursing Leadership.Her engaging style, knowledge of nursing practice and education,and her sense of humor started the summit off on a high note! Dr.Scott summarized what we know about new graduate transition intopractice based on her own research and that of others (see her websiteat http://www.nursing.ecu.edu/fs_details_scottel.html).Attendees also heard from 4 recent graduates from Wyomingnursing programs (two from community college programs, one from theBasic BSN program at UW and one from the BRAND (accelerated)program at UW). Their honest, articulate and heartfelt commentsreassured participants that nursing is in good hands, but also remindedthose listening about the real challenges of transitioning from thesomewhat sheltered world of nursing education to the realities ofclinical practice. One attendee remarked that we needed to hear fromnew graduates every year or two “to remind us just what it is like tobe a new nurse.”What do we know about transition into practice for new nurses? Dr.Scott, based on her research, has developed a model of “New GraduateNurse Transition into the Workplace” based on a socialization processthat links nurses, their educational experience and the organizationwhere they take their first position. In it she posits that studentstransition into a competent practitioner during the first two years ofpractice. This transition is influenced by “anticipatory socialization”and “organizational socialization.”Anticipatory socialization focuses on what happens before the firstjob and encompasses the type of educational program the studentcompletes and the student’s expectations regarding work. In addition,student experiences, based on age, race, marital status, knowledge andskills, life events, family culture, personality and personal hardiness,all influence the transition into practice. For example, transition intopractice can be much more complicated for minority nurses.Organizational socialization addresses what happens when the newgraduate begins their first work experience as a nurse. The new nurseis influenced by the approaches the organization takes for orientationand mentoring, the environmental realities of the organization,including work stress, job demands and organizational culture, andthe fit between the nurse and the environment.The outcomes of this socialization process results in job and careersatisfaction, organizational commitment, intent to stay/leave theorganization, and intent to stay/leave nursing. Unfortunately, for fartoo many new nurses, job satisfaction is not high resulting in a highturnover in the first year of practice.What’s happening in Wyoming to facilitate transition of newMary E. Burman and Matt Sholtygraduates? The WCNHCP funded pilot projects designed to enhancerecruitment and retention and decrease turnover over nurses inWyoming. Several of these pilot projects focused on aspects oftransition: 1) expansion a graduate nurse residency program to 12months, 2) development of preceptor orientation modules, and 3)creation of a leadership institute to enhance nurse manager leadershipcompetencies thus enhancing the workplace environment. The finalevaluation of these pilot projects is almost completed and you willhear more about these in a subsequent column.Are there resources nurses can use to facilitate the transition ofnew graduates? Yes, the National Council of State Boards of NursingThe most wonderful feeling is knowing thatthere are people around you who support you andare there to help you… The more encouragementI get, the better I can function as a nurse.(NCSBN) has a key initiative focused on new graduate transition.The Council has developed a toolkit which is available on line athttps://www.ncsbn.org/1603.htm.Mark your calendar. The 2011 Nursing Summit is scheduledfor September 23 and 24 in connection with the Wyoming NursesAssociation annual meeting in Gillette. Stay tuned for moreinformation about both the Summit and the WNA meeting.The WCNHCPs is the nursing workforce center for the State ofWyoming. The mission of the center is to strengthen the nursingworkforce through on-going collaboration, communication,and consensus building to meet the health needs of the people ofWyoming. For further information, please visit the WCNHCP’swebpage at wynursing.org.Mary E. Burman Co-Chair, WCNHCP Advisory Board,Matt Sholty Office Associate, WCNHCPWyoming Nurse Reporter 7

P Q R S T(Practice Questions Requiring Substantial Thought)Q I have some questions regarding mixingdrugs. These questions would mainly applyto an Infusion Center, but may also bepertinent to an Oncology Office. 1) Canan RN add sterile water to a vial of Cathflofor the purpose of de-clotting a port orpicc line? ; 2) Can an RN mix medicationssuch as Aloxi, Decadron and normalsaline for the purpose of pre-medicationfor chemotherapy regimens; 3. Can anRN add medications such as anti-emetics,potassium, etc., to a bag of fluids? Also,in the past the nurses have also mixed thechemotherapy medications, though we arenot currently doing that, is that somethingwe are legally permitted to do?A The Board of Nursing does not regulatethe compounding of drugs, just the practiceof Nursing. Nurses administer medicationsand this sometimes involves preparing themfor administration (as with Cathflo or manyIV antibiotics). Most of your questions canbe answered by your specific facility policy/procedure. Facilities have many of theirown policies which are written to be incompliance with regulations. The new sterilecompounding rules (USP 797) are supposedto apply to practice everywhere includingdoctor office, clinic, infusion center, hospital,etc. You may also refer to Chapter 17 of theBoard of Pharmacy regulations.recertifications, medication reviews, andsupervisory visits be done by an LPN underthe direction of an R.N.? And if so, how isthis regulated by the state? I would reallyappreciate your input on this matter.A Thank you for writing to the WSBN. OurRules and Regulations, Chapter 3, Section 3,define LPN practice as “Collecting, reporting,and recording objective and subjective datain an accurate and timely manner. Datacollection includes observations about thecondition or change in condition of theclient”This of course refers to nursing practiceand the healthcare of patients. You aredescribing an administrative function of yourorganization. WSBN does not determine norrule on federal insurance guidelines or facilityadministrative policies regarding the fillingout of paperwork. If any of the activities youmention require assessment and evaluationas opposed to just data collection, the ruleswould indicate that these are RN functions.Q We have a Home Care client who needsdaily lidocaine patches applied to their backin an area they can’t reach. Is it within thescope of the Certified Nursing Assistant toassist with the application of a Lidocainepatch to the thoracic back to a patient inthe home setting.to ‘Assisted Living Facility Rules, Chapter12 Section 6’and the specifics of thoseguidelines. It also states a CNA may assistthe patient with their self medication byopening packaging and applying topicalointments.Based on these guidelines it would appearthat once a licensed Nurse assesses the clientfor their particular needs in relation to alidocaine patch and determines the patientis cognizant of the process and placementof such a topical patch, the CNA in theircapacity of providing assistance with selfadministration of medication should be ableto assist with placement in an area difficultfor the patient to reach. Of note is the factthat the CNA must not be delegated thetask of assessing the skin or determiningwhether the patch may be used or not. Theirdelegated task is only of assisting the patientwith placement or preparing the medicationfor topical application.This delegation does not apply to othertopical patches such as the controlledsubstance, Fentanyl. Fentanyl is not atopical, but transdermal delivery system andthere is a potential of misuse, diversion, anddestruction of the patch integrity if cut.For a detailed examination of the rules andtheir wording, please refer to the Rules andRegulations found on the WSBN website. Ihope that gives you some guidance for yourpatient.Q I am an RN working in a Home Healthagency in Wyoming. I work closely withan LPN and was wondering what theregulations were as far as what paperwork(oasis) can be completed by an LPNunder Medicaid, Medicare and insuranceguidelines. Our policy allows only anRN to complete the oasis, however, canA Chapter 7, Section 7, item (K) of theR&R identifies basic nursing functions thatmay be delegated to the CNA, in particular“Assisting with the self-administrationof medications…”. Subsections of thisitem state that a licensed nurse must assessthe client for awareness of their particularmedication and it makes several referencesQ I am an LPN recently employed by anassisted living facility and have a lot ofquestions. I have been searching for therules and regs for the nurse’s role in assistedliving. Can you please guide me to these?A The role of the nurse in assisted8 Wyoming Nurse Reporter

living is defined by the policies of your facility.Your scope of practice however, is the basis ofyour professional education and is defined inChapter 3 of Rules and Regulations found onthe WSBN website under the informationtab. Keep clear in your mind the differencesbetween an RN and an LPN regardingassessments vs. collecting and reportingdata and that an LPN functions under thedirection of an MD, APRN, or RN.Q I work in an ER setting. After hoursit is the nurses responsibility to not onlytriage, evaluate and treat the patient....wealso collect demographic data and insuranceinformation in order to admit the patientinto the system. I have been told in thepast this is not legal, that nursing shouldnot be handling payment and or insuranceinformation with patients but wanted tohear the board’s thoughts on the matter. Wetruly become the admissions clerk, CNA,triage nurse, primary nurse, housekeeping,security ect.....I just want to make sure wearen’t doing anything wrong.A Again, it is the facility that dictates theadmissions policy you describe. The Board ofNursing is only concerned with the practiceof nursing as defined by the NPA and theRules and Regulations that govern practice.If someone tells you something is not legalhave them provide citation to that effect.Q It is mandatory to report an RN that hasterminated?A I assume you are referring to “terminated”as in ended employment. WSBN does notneed to be informed of every employeeaction. However, the Nurse Practice Act(NPA) makes clear that any terminationshould be reported if it involves any of thegrounds in statute 33-21-146. It also providesindemnity for making reports to the board ifdone in “good faith without fraud or malice”(33-21-150). WSBN will determine if actionneeds to be taken after a report is made. Forthe details of the reportable behavior refer tothe NPA found on our website. Reportingforms (under compliance)may also be foundthere.Individual nurses or CNAs are also underan obligation to report an individual whothey believe to be impaired or involved inbehavior contrary to nursing standards.Q Can an RN take verbal and phone ordersfrom CRNA’s?A A Certified Registered Nurse Anesthetist(CRNA) is an Advanced Practice RegisteredNurse (APRN) and as such is classifiedas a Primary Care Provider (PCP) and anindependent practitioner in this state. Theyare responsible for the medical managementof patients under their care. As such, theRN most certainly can take orders, written,verbal, or phone based, from such a provider.Q I am certified as a wound care nursethrough the WOCNCB. With thiscertification, am I allowed to debridewounds in the state of Wyoming?A A clinician can become certified inwound care. Certification courses includedebridement as part of their overall curricula.Nurses should look for courses accredited bythe Wound Ostomy and Continence NursingCertification Board. (Courses for physiciansand physical therapists are overseen by theAmerican Academy of Wound Management.These result in Certified Would CareSpecialist and Certified Wound CareAssociate titles.)My question for you is did your Woundcertification prepare you to do debridementand are you competent to provide thisservice? Will you be providing this serviceunder a Doctor’s order or are you making thewound management decisions as part of yourjob? Does your facility allow you to providethis service? To determine scope of practiceI refer you to the Decision Tree Modelfound on our website under Opinions. Thealgorithm helps the individual determinewhether the specific skill is within theirScope of Practice. Work through it and youshould have your answer.Q We have three LPNs, two of them donot have the basic IV course and thereforedo not start any IVs at our facility. Do theyneed to take a course prior to completion oftheir license renewal?One LPN has been certified in the WYapproved IV course, she expects to beaccepted in the LCCC LPN to RN courseas of January 2011, does she still need toContinued on page 10LICENSETROUBLE?SUSPENSION?SEEKINGREINSTATEMENT?Have you received a letter forsuspension or discipline? You workedhard for your license so don’t make anuninformed decision about the futureof your career. Remember you haveoptions and we can help.PROFESSIONALSHELPINGPROFESSIONALSWOODHOUSE RODEN, LLCAttorneys at Law1912 Capitol Avenue, Suite 500Cheyenne, WY 82033307/432-9399Partner: Gay Woodhousegaywoodhouselaw@aol.comPartner: Deborah Rodendebb@woodhouseroden.comAssociate: Tara Nethercotttara@woodhouseroden.comWyoming Nurse Reporter 9

take the refresher IV course to get herLPN license renewed prior to Dec. 31,2010?A Your LPNs may renew their LPN licensesat any time between now and the end ofDecember. LPNs are not required to haveIV recognition to renew their LPN license.If they renew only their LPN license theymay take courses to obtain IV certificationlater on. To obtain or retain their IVtherapy recognition they need to take (an)appropriate course(s) and submit proof ofcompletion. This year LPNs are requiredto take an IV refresher course or submit 10CE hours related to IV therapy from thepast 2 years to keep IV recognition. Thisrequirement will continue for all LPNs withIV certification every renewal period so keepyour eyes open for CEs related to IV therapyover the next 2 years.Q Is it within the scope of the CertifiedNursing Assistant to assist with theapplication of a Lidocaine patch to thethoracic back to a patient in the homesetting?A Chapter 7, Section 7, item (K) of theR&R identifies basic nursing functions thatmay be delegated to the CNA, in particular“Assisting with the self-administration ofmedications…”. Subsections of this itemstate that a licensed nurse must assess theclient for awareness of their particularmedication and it makes several referencesto ‘Assisted Living Facility Rules, Chapter12 Section 6’and the specifics of thoseguidelines. It also states a CNA may assistthe patient with their self medication byopening packaging and applying topicalointments.Based on these guidelines it would appearthat once a licensed Nurse assesses the clientfor their particular needs in relation to alidocaine patch and determines the patientis cognizant of the process and placementof such a topical patch, the CNA in theircapacity of providing assistance with selfadministration of medication should be ableto assist with placement in an area difficultfor the patient to reach. Of note is the factthat the CNA must not be delegated thetask of assessing the skin or determiningwhether the patch may be used or not. Theirdelegated task is only of assisting the patientwith placement or preparing the medicationfor topical application.This delegation does not apply to othertopical patches such as the controlledsubstance, Fentanyl. Fentanyl is not atopical, but transdermal delivery system andthere is a potential of misuse, diversion, anddestruction of the patch integrity if cut.For a detailed examination of the rules andtheir wording, please refer to the Rules andRegulations found on the WSBN website.Q What is the current decision as to theeducational requirements for nurses whenit comes to the use of C- Arm? In theAmbulatory surgery setting is formalmanufacturer training mandated or, is afacility specific education suitable for thistype of equipment? Since it is a type offluoroscopy and we would like to makesure our nurses meet the Board of Nursingguidelines of practice.A1 Thanks for writing to the WSBN. Foran answer to this question I refer you to theDecision Tree model (which may be foundon our website under Opinions). WSBN nolonger makes standard rulings on Scope ofPractice, instead deferring to each individualnurse to follow the decision algorithm todetermine if they have the knowledge andskills necessary to provide safe patient careand are willing to accept responsibility fortheir decision.In the case of using the C-arm (LargeC-shaped fluoroscopy imaging device usedin cath lab and other invasive procedures)I would expect manufacturer training tobe more complete and geared to troubleshooting while facility specific training to bemore limited to typical usage. Of course, itwould all depend on the skill and knowledgeof the trainers. Each individual facility isresponsible for ensuring that their employeesreceive adequate training to provide forpatient safety. If an RN feels unprepared touse the C-arm they should defer from suchan assignment until they feel confident theyhave had adequate training. Please lookover the Decision Tree and let me know ifyou have any other questions.A2 I wanted to follow up on the discussionfrom earlier. I referred you to the DecisionTree regarding whether an RN may use aC-Arm in their scope of practice.The 2nd section of the Decision Tree states“Is the activity precluded under any otherlaw, rule or agency policy?”The American Society of RadiologicTechnologists (ASRT) position statementscan be access at the following link: https://www.asrt.org/media/pdf/governance/HODPositionStatements.pdfOn page 1 of the Position Statementsyou will find the statement that R.T.’spracticing radiography (which includesfluoroscopy) are to be certified by agenciessuch as the American Registry of RadiologicTechnologists. Also on page 3 you will findthe statement that fluoroscopy is within thescope of practice of R.T.’s with clinical anddidactic education where federal or statelaw and institutional policy permits. Andfinally on page 5 you will find the statementthat the ASRT opposes the employmentor utilization of uncertified or unlicensedindividuals to administer ionizing or nonionizingradiation procedures.In the Wyoming Technologist ExaminersPractice Act, Chapter 2, Section 1. Titled:“License Required: paragraph (a) you willfind the following excerpt:No individual shall perform any actspecifically authorized for a technologist ortechnician nor function as a technologistor technician nor represent himself/herselfas a technologist or technician unless thatindividual holds a current license issued bythe Board.It would appear that the State of Wyomingdoes not have provisions for registerednurses to perform radiologic technologistfunctions without a license provided by theWyoming Board of Radiologic TechnologistsExaminers. However, we advise that youcontact the Wyoming Board of RadiologicTechnologists Examiners to determinecompliance activities for registered nurses.This is an instance where knowledge of allthe laws is required to make a final decisionregarding scope of practice. Ignorance of thelaw isQnever a good excuse.If you have practice questions please write toWSBN at wynursing@state.wy.us& a10 Wyoming Nurse Reporter

Reprinted from the October 16, 2008 edition of the Wyoming Tribune-Eagle with permission of CheyenneNewspapers, Inc., Copyright 2008. All rights reserved.Everyone who has renewed their license by now realizes that Wyoming has gone to a paperless licensing system. We are eliminating paper licensesbecause it puts the public at risk from deceptive practitioners or frauds. New technologies make it easier than ever to produce deceptively officiallookingdocuments that misrepresent the facts. Verification of your nursing license or certificate can be done FREE OF CHARGE, 24-hours aday, any day. Please work with your employer and the board to protect the public by using our website service.The following article highlights the issue better than we ever could:Woman Gets Probation forFaking Mental Health LicenseCHEYENNE - A local woman was arrestedMonday on suspicion of forgery andpracticing as a mental health counselorwithout a license at Cheyenne RegionalMedical Center. Authorities allege LoreeD. Sanchez used a forged counselor’s licenseto defraud an insurance company andCRMC. The 33-year-old Cheyenne residentfaces two felony counts of forgery and onemisdemeanor count of practicing without alicense, according to Laramie County CircuitCourt documents.“I would say this is uncommon - quiteuncommon - and takes a certain degree ofsophistication and preparation,” DistrictNursingExcellence inWyomingSign-on Bonus andRelocation Assistance- Director of Med/Surg- OB, ER, Med/Surg RNs.Attorney Scott Homar said.Police arrested Sanchez at 1:20 p.m. Mondayat her home, 2802 Snyder Ave, after awarrant was issued. If convicted of onefelony count of forgery, Sanchez could faceup to 10 years in prison, a $10,000 fine orboth. Julie Herrera, who lives with Sanchez,said Sanchez is a great person.“Her position there is not medical by anymeans, so it doesn’t affect people other thanhaving someone to talk to,” she said.Veronica Skoranski, occupationallicensing director for the state of WyomingProfessional Licensing Administration, filedthe complaint with the police department.Skoranski explained that a master’s degreein counseling is required from an accreditedprogram to obtain a license.Certified counselors also must complete atleast 3,000 hours of supervised clinical workand pass a National Counselor Examination.There are 127 licensed professionalcounselors in Cheyenne, Skoranski said.Skoranski said the situation surprised her. “Itonly would have taken a two-minute phonecall to verify she was licensed,” Skoranskisaid of the hospital.Riverton Memorial Hospital is committedto nursing excellence. Join our team andmake a difference in an environment whereyou will be appreciated. We providemedical, dental, vision, Life, AD&D, STD,LTD, EAP, 401(k), PTO, EIB, andcompetitive wages. EEOCall 307-857-3465 oremail norma.atwood@lpnt.netVisit www.Riverton-Hospital.comWyoming Nurse Reporter 11

Health Care Providers’ Responses toMedical Traumatic Stress in Their PatientsReprinted with permission from: The Health Care Toolbox: www.healthcaretoolbox.orgWorking with ill and injured childrenand families can be professionallymeaningful and satisfying. But health careproviders treating children and familieswho are undergoing challenging medicalconditions and treatment can sometimesfeel drained, upset, or frustrated. This maybe especially true during times of increasedworkloads or heightened personal stress.Sometimes these very human responsesget in the way of being optimally effective atwork – contributing to tension or conflictswith patients’ families, or to stresses withinthe health care team.A study by the Association of Professorsof Medicine (2004) estimated theprevalence of burnout among physiciansin the US at 22%. As part of a larger studyon burnout in physicians, Deckard andcolleagues (1994) found that 58% of the59 pediatricians studied scored high onemotional exhaustion measures.In responding to the pain and distressof children and families, the researchsuggests that the ability to identify,understand and manage one’s emotionalreactions is paramount. In doing so, providerself-care is key.When working with children and familieswith complex and challenging illnesses orinjuries, it is recommended that health careproviders routinely:• Be aware of their own emotionalreactions and distress when confrontingothers’ traumatic experiences, and knowwhat traumatic material may triggerthem.• Connect with others by talking abouttheir reactions with trusted colleagues orothers who will listen.• Maintain a balance between theirprofessional and personal lives, witha focus on self-care (e.g., relaxation,exercise, stress management, etc.)to prevent, and lessen the effects of,workplace stress.IMPORTANT FINDING: Lopez-Castillo and colleagues (1999) anonymouslysurveyed clinical health care professionalsworking in infectious disease, hemophilia,oncology, and internal medicine at fourhospitals. Out of the 196 respondents, 38%reported diagnostic levels of psychologicaldistress, including depression, anxiety, andimpaired functioning; a rate comparable tothose of their patients.Self Care Tips:Each provider may have a different way ofcoping with work-related stresses. These aresome practical strategies that may be helpfulin preventing and reducing the effects ofstress reactions:In your daily routine:• Be sure to eat sensibly and regularlyevery day• Get adequate sleep each night• Exercise regularly• Be aware of your stress level; takeprecautions against exceeding yourown limits• Acknowledge your reactions to stressfulcircumstances; allow yourself time tocope with these emotionsAt work:• Try to diversify tasks at work, or vary yourcaseload, to the extent that you can• Take breaks during your workday• Take vacation days• Use relaxation techniques (e.g., deepbreathing) as needed• Talk with colleagues about how yourwork affects you• Seek out, or establish, a professionalsupport group• Recognize your personal limitations; setlimits with patients and colleaguesOutside of work:• Spend time with family and friends• Stay connected with others throughcommunity events, religious groups, etc.• Engage in pleasurable activities unrelatedto work, especially those that allow forcreative expression (writing, art, music,sports, etc.)• Be mindful of your own thoughts andfeelings; replace cynicism with positiveself-talk and reaffirmations• Engage in rejuvenating activities suchas meditation, prayer, or relaxation torenew your energy• Seek therapy if you think it would behelpfulRed Flags:Be on the alert for these immediate stressresponses and/or long-term effects:12 Wyoming Nurse Reporter

Physical Reactions• Fatigue• Sleep disturbances• Changes in appetite• Headaches• Upset stomach• Chronic muscle tension• Sexual dysfunctionEmotional Reactions• Feeling overwhelmed/ emotionally spent• Feeling helpless• Feeling inadequate• Sense of vulnerability• Crying more easily or frequently• Suicidal or violent thoughts or urgesBehavioral Reactions• Isolation, withdrawal• Increased mood swings• Irritability• Restlessness• Changes in alcohol or drug consumption• Changes in relationships with others,personally & professionallyCognitive Reactions• Disbelief, sense of numbing• Replaying events in one’s mindover & over• Decreased concentration• Confusion• Impaired memory• Difficulty making decisions or problemsolving• Disturbing dreams or fantasiesThe key is for individual nurses to be ableto identify their unique triggers and build awide range of coping strategies that they canapply to particular situations... Compassion,often the ultimate gift of nurse to patient,must be nourished to be sustained.-Maytum, 2004References:Association of Professors ofMedicine. Predicting andpreventing physician burnout:Results from the United Statesand the Netherlands. Am J Med.2001:111:170-175.Deckard G, Meterko M,Field D. Physician burnout:an examination of personal,professional, and organizationalrelationships. Med Care.1994;32(7).Lopez-Castilo J, Gurpegui M,Ayuso-Mateors, et al. Emotionaldistress and occupational burnoutin health care professionalsserving HIV-infected patients:A comparison with oncologyand internal medicine services.Psychotherapy & Psychosomatics.1999:68:358-356.Maytum JC, Heiman MB,Garwick AW. Compassionfatigue and burnout in nurses whowork with children with chronicconditions and their families. J PedHealth Care. 2004;18(4):171-179.Websites and online resources:The American Academy ofPediatrics offers online resourcesfor physician health and wellnessThe International Society forTraumatic Stress Studies hasa webpage addressing indirecttraumaIdaho State University maintainsa webpage of resources aboutsecondary traumatic stress for thehelping professionsThe Texas Medical Association’sCommittee on Physician Healthand Rehabilitation offers onlineand home study courses relevantto self-careAdditional Reading:Journal Articles:Badger JM. Understandingsecondary traumatic stress. Am JNurs. 2001;101(7):26-32.Kazak AE, Blackall GF, BoyerBA, et al. Implementing apediatric leukemia interventionfor procedural pain: the impacton staff. Families, Systems &Health. 1996;14(1):43-56.LeBlanc P, Bakker AB, PeetersMCW, et al. Emotional jobdemands and burnout amongoncology care providers. Anxiety,Stress, & Coping. 2001:14:243-263.Madrid PA, Schacher SJ. Acritical concern: pediatricianself-care after disasters. Pediatrics.2006; 117: S454-S457.Meadors P, Lamson A.Compassion fatigue and secondarytraumatization: provider selfcare on intensive care units forchildren. J Ped Health Care.2008;22(1):24-34.Stamm BH. Work-relatedsecondary traumatic stress. PTSDResearch Quart. 1997;8(2):1-3.Witt Sherman D. Nurses’ stressand burnout. American Journal ofNursing. 2004;104(5):48-56.Books:Treating Compassion FatigueCharles Figley, Brunner-Routledge; New York; 2002.Help for the Helper: ThePsychophysiology of CompassionFatigue and Vicarious TraumaBabette Rothschild, W.W. Norton& Co.; New York; 2006.Overcoming Secondary Stress inMedical and Nursing Practice: AGuide to Professional Resilienceand Personal Well-Being RobertJ. Wicks, Oxford UniversityPress; New York; 2005.This article was written by theStaff of the Center for PediatricTraumatic Stress, The Children’sHospital of PhiladelphiaWyoming Nurse Reporter 13

The Truth About Nursing:Organization Founded to Monitor Media Portrayals of NursesWhat is the purpose of your organizationand website (TruthAbout Nursing.org)?SANDY SUMMERS: The Truth AboutNursing works to change how the world thinksabout nursing. For decades the public hasthought of nurses in stereotypical terms, andthe media both reflects and reinforces thoseviews. People may see us as self-sacrificingangels who clean up the mess but who dolittle to advance health beyond assisting theheroic physicians, who are seen as the mastersof all health care. Alternatively, nurses areportrayed as the naughty sexual servants orplaythings of physicians and/or patients. Thisdeep undervaluation of the profession is aroot cause of many of the more immediateproblems nurses face, including inadequateclinical and educational resources. Whyworry about nurse staffing if we’re mostlythere to fluff pillows and fetch physicians?The Truth About Nursing raisesawareness in many ways, including advocacycampaigns, media analysis and othereducational activities, and collaborationwith nursing groups and media creators. Ourwebsite www.TruthAboutNursing.org is themain vehicle we use to inform nurses, mediacreators, and the public about how the mediais portraying nurses. We post media analysesof what we see and hear, and launch letterwritingcampaigns if something is especiallydamaging to nursing.We also explore the main stereotypes inour book Saving Lives: Why the Media’sPortrayal of Nurses Puts Us All at Risk, whichhas just come out in an updated paperbackedition. In the final two chapters of thebook we lay out a plan to resolve nursing’simage problem. As with any problem nursesface, it’s not enough to identify the problem.We’ve got to come together and educate theworld about the true value of nursing.What was the catalyst for establishingyour organization and website?A group of graduate nursing students atJohns Hopkins, including me, got togetherin 2001 and had a dialogue about the linkbetween policy decisions that underminednursing and what we saw was a widespreadundervaluation of the profession. We askedourselves, where does the undervaluationcome from, why does it exist? It seemedpretty clear that much of the publicdisrespect stemmed from the stereotypicalmedia portrayals of nurses and an overall lackof public understanding. We talked aboutwhat we might do and decided to form ournon-profit organization to make a persistenteffort to resolve nursing’s image problem.How do you feel about how nursing isbeing portrayed in the media in 2010?It remains generally pretty poor, althoughthere have been some good portrayals andreasons for hope, like the Hollywood nurseshows that appeared in 2009. We wish wecould say that nine years after we began,nursing’s image problem was mostly fixed!But when you’re trying to make such afundamental change—changing the wayFor decades the public has thought of nurses in stereotypicalterms, and the media both reflects and reinforces those views. Peoplemay see us as self-sacrificing angels who clean up the mess but whodo little to advance health beyond assisting the heroic physicians,who are seen as the masters of all health care.people have thought about nursing theirwhole lives—you’re really talking aboutsomething on the order of a 50- or 100-yearplan. The most popular Hollywood productsgenerally continue to portray nurses asperipheral assistants to the physicians who doeverything that matters. Major advertisersworldwide still rely on the naughty nurse,and even the news media tends to portrayphysicians as the sole health experts, even inareas in which nurses know more and take thelead. I should add that the distortions aboutnurses are hardly ever intentional; they’realmost always based on ignorance. So we’vejust got to keep reaching out and educatingthe media and the public about what nursesreally do to save lives and improve outcomes.I do think nursing’s image has made someprogress in the past few years. The print mediais slightly more likely to consult nurses on itsstories. We haven’t seen a major mainstreamnaughty nurse ad in the US in about threeyears, though there is still plenty of thatimagery around. And this past year we had anamazing three—count them, three—nursecenteredHollywood television shows (NurseJackie, Mercy, and HawthoRNe) appear after15 years without a single one. Each of thesenew shows, despite some flaws, has includedmany helpful portrayals of nursing skill andautonomy. So, while it’s a long road andwe still have much to do, we also think ourvoices are beginning to make a difference.The problem is not just that mediastereotypes are demoralizing and degrading tonurses and other health professionals. Theyalso send the message that physicians are theonly ones who matter, so they’re the onlyones who deserve funding for their work, thatonly they deserve seats at decision-makingtables on hospital boards or at the NationalInstitutes of Health (NIH). Speaking of theNIH, nurses get only 1/2 of one percent ofthe NIH budget for nursing research—a truemeasure of the lack of value society places onnursing. As the largest health profession withleaders working on the cutting edge of healthcare, nurse researchers need funding for theirwork. Nursing scholars can’t get adequatefunding when most people don’t know thatthey exist.What “hot topics” have you beentackling lately?We make a serious effort to monitorU.S. television portrayals of nursing and atremendous number of health care showshave debuted in the past year. The 2009nurse shows have been the hottest thingsfor us lately since virtually every episodehas had something notable for nursing. Thephysician-centric hospital shows MiamiMedical and Three Rivers broadcast less thana full season of episodes before they werecanceled. Also new since 2009 is Royal Painswhich focuses on a boutique physician, but itgenerally does not touch on nursing.Several new shows are slated to appearsoon. We’re not looking forward to the showOff the Map—about health care in thejungle—since the creator Shonda Rhimeshas such a poor history of nursing depictions16 Wyoming Nurse Reporter

The Truth About Nursingraises awareness in manyways, including advocacycampaigns, media analysis andother educational activities,and collaboration withnursing groups and mediacreators. Our website www.TruthAboutNursing.org is themain vehicle we use to informnurses, media creators, and thepublic about how the media isportraying nurses.with her shows Grey’s Anatomy and PrivatePractice. A brilliant medical examinerwill be featured in Body of Proof, and ERproducer John Wells is working on a newhealth show featuring Sissy Spacek, thoughit is not clear if that show will air. There’s alsoCali Nurse, a new reality show in productionfeaturing angel and naughty nurse images,which recalls Aaron Spelling’s notoriousNightingales from the late 1980s that nursesmanaged to bounce off the airwaves withtheir protests.What is the source of the best fictionalportrayal or [non-fiction] reporting onnursing today?The new nurse shows Mercy, NurseJackie and HawthoRNe. We’re sad thatMercy was canceled at the end of its firstseason. But Nurse Jackie was renewed for athird season. Both of those engaging showsportrayed a team of nurses tackling patienthealth problems with autonomy, insight,skill and inventiveness—saving lives andimproving outcomes. HawthoRNe is not asstrong dramatically, but also has some goodportrayals. Each of the nurse-centered showshas had some problems in depicting nursingautonomy, and some of the characters havepersonality and even ethical flaws, but thenurses are clinical experts who advocate forthem as if they were the nurses’ own familymembers.The news media has made some slightimprovements and will occasionally conveynursing expertise in the key role nurses playin health care. For example, the influentialNew York Times occasionally runs articlesthat gives nurses due consideration such as aJune 29 article about geriatric care. The BBChas also run several helpful articles aboutnursing care and innovations. Unfortunately,the vast majority of health news storiesremain physician-centric, consulting onlyphysicians even about topics in which nurseshave at least as much expertise.What is the worst portrayal of nursingtoday?Unfortunately, on the physician-centricshows, the same themes continue to occur:physicians dominate all health care. Nursesare their servants, losers who are sometimesthrow-away love interests, or wanna-bephysicians.Grey’s Anatomy is probably the worst,though House is close. In these shows, everymajor character is a physician, and nurses aregenerally just dim or disagreeable servants.On Grey’s in particular, nurses are carpingsecond-class losers who have settled for beingnurses because they don’t have what it takesto be like the heroic surgeons, who provideall meaningful health care.Private Practice had a nurse-midwife, butthe show killed him off in May because it didnot know what to do with him. Before he died,he got accepted into medical school, which isa standard Hollywood path to success for ablenurses, but one that is actually an insult tothe nursing profession because nurses are 100times more likely to attend graduate schoolin nursing.House is less focused on patient care,but it also suggests that nurses fetch thingsfor physicians and clean up patient messes.Sometimes nurses in these shows exist onlybelow the elbow, so they can hand thephysicians equipment so they can use itto perform nursing work. Such depictionssend the message that nurses do nothingmeaningful and that if you want to undertakea serious health care career, the only optionis medicine.On both House and Grey’s, brilliant leadcharacters have mocked nursing, with no realrebuttal.Don’t all professions get “lampooned?”Why should nurses be spared the comedicor dramatic treatment?Of course, all professions should be subjectto fair criticism, but what nurses should objectto is the decades of harmful stereotyping thathas helped to fuel a global public health crisis.“Just joking” is no defense to harmful slurs inother contexts. We’re not saying nurses can’tbe criticized. There are real problems withnursing that could and should be examinedby the media, including nursing errors andoccasional weak advocacy for their patients.Continued on page 18Wyoming Nurse Reporter 17

Many nurses I speak withrealize the media depictionsof nursing are pretty bad, butthey seem to regard our mediaimage as something completelybeyond our control. They thinkinfluencing the media is aboutas easy as moving the AtlanticOcean. And some don’t seemto understand why the mediamatters. So instead of joining usto work on it, they ask us whywe don’t focus on problems theysee before them like high patientloads and mandatory overtime.We welcome fair criticism by the media.Public scrutiny of these issues can only helpmake nursing stronger.But we object to stereotypes of nurses.No thinking person would accept racial orgender stereotypes along those lines. Butsociety seems too eager to accept stereotypesof nursing as being low-level “women’s work,”and nurses may be depicted as scut workservants or in-hospital prostitutes. The sexyangle for nurses hurts nurses since it impliesproviding sexual services is a part of nurses’jobs—some sort of in-hospital prostitutes.Sexiness associated with men just makesthem look more attractive.Many professions in which popular culturetakes an interest also suffer from mediastereotypes. There are frequent depictionsof greedy, unethical lawyers, sexy firefightersand brilliant physicians. But depictions oflawyers are not all bad. They fight for justice,are smart, committed advocates for justice.And real lawyers are rich and powerful,so whatever stereotype they’ve suffered, itdoesn’t seem to have harmed them. There’sno global lawyer shortage. That firefightersare depicted as macho and sexy hasn’t harmedthem, no one thinks it’s their job to have sex,as they do with nurses. Rather the sexinessassociated with firefighters makes them lookstrong, virile and manly—it makes them aprize romantic catch.And frankly physicians haven’t beenlampooned by any media, they’re consistentlystereotyped as brilliant and expert, doing allthe work of substance. They may be flawed,three dimensional characters, but they savelives, they’re autonomous cowboys and girls.Their competence is rarely if ever questioned,even when the character is despicable. Sothe media has been a boon to them for manydecades.Of course, nurses aren’t the only oneswho are harmed by stereotypes. TheNational Association of Social Workershas recently launched socialworkersspeak.org, a website that monitors the media fornegative stereotypes about social workersand encourages action to counteract thestereotypes.When you do speaking engagements andcommunicate with nurses, what frustrationsdo you detect with regard to how nursesfeel about the media?Many nurses I speak with realize the mediadepictions of nursing are pretty bad, but theyseem to regard our media image as somethingcompletely beyond our control. They thinkinfluencing the media is about as easy asmoving the Atlantic Ocean. And some don’tseem to understand why the media matters.So instead of joining us to work on it, theyask us why we don’t focus on problems theysee before them like high patient loadsand mandatory overtime. But our answeris that we do focus on these problems—bychanging how people think about nursing.The decisions to overload nurses come fromhuman beings who undervalue nursing careand are ignorant of nurses’ ability to savelives. So decision-makers overwork nurses,ultimately leading to bad patient care andmiserable nurses.Many decisions that harm nursing happenbecause society believes that nursing isn’treally all that difficult or important. “You canprobably empty more than 10 bedpans a day,I’ll bet you can empty 20!” Decision-makersdon’t know what we do, so they don’t valueit, so they don’t give us the resources we needto do our work right.But if we improve media depictions ofnurses, it will increase the value decisionmakersplace on nursing. We have to changeassumptions about nursing, and that startswith the media and conversations familieshave with each other about the value ofdifferent careers.One of our challenges is to get nursesmotivated to start chapters of The TruthAbout Nursing in their home towns andwork to help us change how society thinksabout nursing. Our small organization hasbeen able to affect many depictions ofnursing in the media. We have a long way togo, but if more nurses join us in speaking outto the media and the public about the valueof nursing—we will get there one day.Are there any producers in Hollywoodwho used to practice as full-time nurses?The three nurse-centered shows haveeach had nurses as producers and it’s clearthey have offered valuable input. There area few errors, especially in relation to nursingautonomy, but for the most part, the showsunderstand nursing. The physician-centricshows also have nurses on staff, and sometimesthey get a producer credit, but these nursesdo not appear to be consulted on the scripts,or in any case, the scripts do not reflect ameaningful effort to portray nursing fairly.18 Wyoming Nurse Reporter

This is where it generally all goes right orwrong, so this is where nurses who are willingand able to advocate for their profession aremost needed. Instead, the physician-centricshows have nurses on the set showing theactors who play physicians how to performall the nursing work accurately. So theirwork undermines nursing. I wish all nurseswould refuse to help these shows when theyportray physicians doing the work that wereally do.As a person who is bringing awareness toan issue of importance for nursing, could youaddress your feelings about the saying “Oneperson can make a difference?”In 2006, Francine Brock of Californiavisited Wynn Las Vegas Casino and cameacross its Nurse Follies slot machines thatfeatured naughty and battleaxe nurses. Shelater wrote to the casino, and with that oneletter, she was able to convince the ownersto convert the slot machines to themes thatwere not nurse-related—a measure that costthe casino about $20,000. Not all lettershave this power, but if we don’t speak, wecan’t expect change to happen.In our mission at the Truth, we sometimesfind it so hard to convince nurses to joinour mission. But in our years of advocacy,we have convinced many media makers,including the U.S. government, Cadbury-Schweppes, Heineken, Wal-Mart, CVS,Skechers and many others to change theirdepictions of nurses to ones that did notdegrade us.This task is big, but it isn’t as big as movingthe Atlantic Ocean. A Chinese parablesays that if you want to move a mountain,you’ve got to begin with a tiny pebble. Hey,we’ve moved a bunch of wheelbarrows fullof dirt by now. If we all grab our shovels,we can create a more robust and accurateimage of nurses. We shouldn’t do it just forourselves or even for the next generation ofnurses. We should also do it for our patients.As their advocates, it’s our job to providethem with better nursing care than we arecurrently able to deliver. But we can’t do ituntil we first make our profession stronger.Please join us at www.TruthAboutNursing.org. We can do it—if you help. We’ll lookforward to having you join us. Thank you.Sandy Summers, RN, MSN, MPH isexecutive director and founder of The TruthAbout Nursing and co-author of SavingLives: Why the Media’s Portrayal of NursesPuts Us All At Risk.Earn Your Bachelor’s or Master’s Degree Online from theUniversity of MaryToday’s nurses must combine expertise intheir field with an ability to lead. A degreefrom the University of Mary will prepareyou to assume leadership positions in directpatient care, management and education.Programs focus on the application of knowledge– you will understand not only what is needed,but how that service is best provided.Programs available:n LPN/RN to Bachelor of Science,Major: Nursingn MSN: Nurse Administratorn MSN: Nurse Educatorn MSN: Family Nurse Practitionerblended online/on-site formatn MBA in Health CareClasses start in May, September and January.Financial aid is available. Learn more today!Classesheld inCasper,Gillette &Sheridan,or online!Casper 232-8402; Gillette 682-2650; toll free 800-408-6279,ext. 8353 • cade@umary.edu • www.umary.edu/cadeThe University of Mary has held continuous accreditation by The Higher LearningCommission, a Commission of the North Central Association of Colleges and Schools,since 1969 and is accredited by the Commission on Collegiate Nursing Education.Wyoming Nurse Reporter 19

Kellie Clausen named winner for theDistinguished Nursing AwardThe Wyoming March of Dimes Nurse of theYear Awards was developed to be a statewideprogram recognizing outstanding nurses in16 professional categories and six additionalcategories, Rising Star, Student Nurse,Student Nurse – Continuing Education,Distinguished Nursing and Legends inNursing. This year’s award ceremony was heldin Gillette, WY where outstanding nurseswho have set the standard for patient care,significantly contributed to enhancing theimage of nursing and whom are perceived asleaders among their peers were recognized.Nurses were nominated by their patients,friends, co-workers and others for the Nurse ofthe Year Awards Celebration.Kellie, Clausen, APRN was the awardwinner for the “Distinguished Nursing”category. This award recognizes a nurse who,over the past 15 years, has made significantcontributions to nursing in Wyoming throughprofessional, community and/or personalachievements.Kellie began her career as an RN receivingan Associates degree from Casper. Shepursued further education, completing herbaccalaureate in order to be recognized asan Advanced Practice Registered nurse.To view Wyoming Nurse Reporteronline, follow these simple steps:• Click on the Wyoming State Boardof Nursing Website address at https://nursing-online.state.wy.us/• On the bar menu to the left seeClick Here to Visit WNR e-pub andclick it!Once you’re there, here are somehelpful tips to help you navigate!• You can click on any headline inyour e-Pub that ‘lights-up,” when youroll over it with your cursor, and itenlarges to a more readable format.• There are even options on that pageto enlarge it further--the three “A s”that appear in the upper right cornerShe continued on to earn her women’sHealthcare Nurse Practitioner certificate andthen completed all requirements to earn hercertification in Adult and Family Practice.As a clinician, she is known for hercompassion to patients from all walks of life,and assures they are provided a bright spotof personalized care. Her superb nursingknowledge and skill lend to excellentdiagnostic skills.She has used her nursing experience andgifts in so many professional and volunteeractivities that they are too numerous tomention but a few highlights:-Adolescent in the 90s, targeted healthDid you know you can read theWyoming Nurse Reporter online?of the page-click one and see.• What you may not have tried is theARCHIVE tab. Click that tab andevery issue that has been produced asan e-Pub will appear and you can openeach just like the new one.• You should also try the SEARCHtab. It is a keyword search. You enterthe name or word you want to readabout and it searches for, and bringsup, each use of that name or wordin any of the issues archived on youre-Pub-and not just the current one—Try it!If you haven’t tried all the “bellsand whistles” on your e-Pub issues ofWNR you are missing out on what agreat and functional tool it can be. Sogo play with e-Pub!education for 10-12 year olds in hercommunity;-co-chair for breast cancer awareness taskforce;-presenter on teen pregnancy panel member;-volunteered with her church group to provideancillary assistance to VOSH International;-Advocate and former Board member forJubilee House which serves as an alternativeliving center for women leaving prison;-Active member of 4H and Boys and GirlsClub programs.She is currently serving her second termas a board member for the Wyoming StateBoard of Nursing. She enhances the imageof professional nursing through her activeparticipation at the region, state and nationallevels. She annually attends and participatesin the National council of State Boards ofNursing APRN roundtable, assuring thatWyoming is represented in these policymaking sessions.Her dedication to women’s health issuesand mentorship has been inspirational toeveryone. She exemplifies what the imageof nursing should be in today’s world. Sheis a very deserving recipient of the 2010Distinguished Nurse of the Year Award.20 Wyoming Nurse Reporter

Vol. 5 number 3Fall 2009Wyoming State Board of NursingSee story on page 5Vol. 5 number 1Spring 2009Amy Edith Richardson MillerSee story on page 12ReachRecruitRetainNurseR E P O R T E RWyomingNurseWyomingVol. 6 number 4 Winter 2010TwentyRNs Working inSpecialty AreasIs there really a Difference?The ImpairedHealthcare WorkerImpact, Treatment and Monitoring100 Years of ServiceYears Agoin Nursing NewsPQRST(Practice QuestionsRequiring SubstantialThought)WyomingNurseR E P O R T E R1989Free Subscription toThe First LicensedNurse in WyomingStuNurse magazine!R E P O R T E RIt’s nottoo Lateto renewsee page 11Diet, Exercise and AttitudeHow I CHanged My LIfeBy Jeannette HoemMailed to every nurse in WyomingThe WyomingPeggy Hawkins was appointed to the boardto fill the position previously held by KarenSmith. Board of NursingThe board issued three new advisory opinions;Intraosseous Cannulation, Journal Umbilical CatheterLines and Arterial Lines.Board of Nursing meeting highlights included:to reserve advertising spaceo Approved four courses for the ADNcurriculum contact of Southeast Victor Community HorneCollege. vhorne@pcipublishing.como Reviewed and approved additional practicesites and additional collaborating physiciansfor four certified nurse practitioners.1-800-561-4686 ext. 114o Accepted the site visit and revised time-linefor the Our RN1 nursing application journals for Bryan areCollegeof Nursing.mailed directly to over 1.5 milliono Approved the Midland Lutheran Collegeproposal nurses, to healthcare establish the elective, professionals NursingStudent and Leadership. educators nationwide.o Approved Dakota Wesleyan CommunityCollege’s Arizona request to change North Carolina observationalexperience Arkansas for students North in Nursing Dakota Processrelated The District to Childbearing. Ohioo Approved of Columbia Metropolitan Oregon CommunityCollege’s Indiana request to use South Douglas Carolina CountyHospital Kentucky as a clinical South site and Dakota to revisethe Mississippi clinical hours in StuNurse/Nationwidethe practical nursecurriculum.Montana Tennesseeo Received Nebraskaa summary Washington report of the July1989 Nevada RN licensure examination.West Virginiao Recommended New Mexico that Wyoming Charlene Kelly attendthe NLN Baccalaureate and Higher DegreeCouncil meeting.The Board ThinkNurse.comof Nursing Staff was scheduled topresent a program on the role of the Board ofNursing at twelve sites around the state startingJanuary 1990.The National Council of State Boards ofNOW WE KNOW… WHAT TO SAY WHEN ASKED ABOUT ADOPTION.Learn best adoption practices allowing you to better serve thoseexperiencing an unintended pregnancy. The Infant Adoption TrainingInitiative enhances understanding and knowledge about currentadoption practice, laws, birth fathers and referral strategies.For training dates and locations, and for quick and easy online registration, simply visitour Web site at www.infantadoptiontraining.org or contact us at 1.888.201.5061.“All of the information was very beneficial.Thank you for the program.”e d u c a t i o n / e m p l o y m e n tSeptember 2009E D I T I O N 1 3e d u c a t i o n / e m p l o y m e n tOppOrtunities in HealtH lawfor NursiNg Degree HolDersWEST EDITIONE D I T I O N 1 2nationwideMake your educationalJourney SMartThe Art and Science of CraftsTreATmenT of PhySiCAlAnd CogniTive diSAbiliTieSReaching every nursing student/school in AmericaFifth AnnualNursingThis project is funded through the Children’s Bureauof the U.S. Department of Health and Human Services.nationwideThinking Outside the Box:COmBining Caringand TeChnOlOgyReaching every nursing student/school in Americaw w w . S t u N u r s e . c o m 1April 2009CruiseFay W. Whitney School oF nurSingThe Fay W. Whitney School of Nursing has an atmospherethat is friendly, scholarly,Aprilprofessional18-25,and2010forwardminded.Join an exciting and dynamic community whereactive learning and teacher-student partnerships, scholarlypractice, interprofessional education and practice, and ruralhealth care are valued.Fay W. Whitney–Director of NursingContinuing EducationSCHOOL OF NURSING~ Dr. Mary E. Burman, Dean and Professor· State-of-the-Art nursing school with SimulationCenter for hands on experienceCruise your way to Nursing CE Credits· Offering three ways to obtain a baccalaureateon the Mexican degree in Riviera nursing aboard Carnival’s Newestand Biggest ship –· Offering two graduate degrees: Nurse Educator andNurse Practitioner (FNP or PMHNP)Splendor!Sunday, Apr 18 – Los Angeles (Long Beach), CAMonday, Apr 19 – Fun Day At SeaDo you know someone who is a student nurse, orsomeone considering a nursing career? Then let themknow about the StuNurse magazine. A subscriptionto the StuNurse digital magazine is FREE and can bereserved by visiting www.StuNurse.com and clicking onthe Subscribe button at the upper right corner.Educators…let your students knowthey can subscribe free of charge!· UW graduates are highly valued throughout Wyomingand the regionOn the Peak of Excellence!Accredited by the Commission on CollegiateNursing Education (CCNE) Who said Continuing Education can’t be fun?Fay W. Whitney School We oF are nurSing changing that forever. JoinThinkAboutItNursing and Poe Travel for a CE Cruisewww.uwyo.edu/nursing • (307) 766-4312that will cure your overworked blues with some salsaand sun on Carnival’s newest, biggest ship- Splendor.While you’re touring the Mexican Riviera, you canearn your annual CE credits AND possibly write thetrip off on your taxes. How is that for paradise?Wyoming Nurse Reporter 21Prices for this cruise and conference are basedon double occupancy (bring your friend, spouse or

LOOKING FORflexibility?You’ve come to the right place.In MemoriamWSBN was notified of the death ofa licensee who recently passed away.Currently recruiting:RN’s, LPN’s and CNA’swith current WY license• Julie Kimball, RNThe members and staff of WSBNwish to extend our condolences tothe family and friends of this valuedcolleague.Interim Healthcare offers you the career flexibility you’ve been looking for. We’re the nations largest combined provider ofhome care and medical staffing and we have over 40 years of experience in finding the right opportunities for nurses justlike you Whether you’re looking for full-time, per diem or permanent placement, we offer competitive salary and benefits.Apply online or give us a call.www.careersbyweb.com1010 East 1st Street, Suite A Casper, WY 82601307-473-5569The Spring Issue will CelebrateNurses for Nurses’ Week! Weinvite everyone to send in yourstories, poems, and letters topattifgardner@aol.com We wouldlove to see how many of you wouldtake a few minutes to complete thefollowing sentence and send it in tous--“My best day ever as a nurse (ornursing assistant) was…………”Nurses and Physicians involvedin a Sigma Theta Tau LeadershipProject at Cheyenne RegionalMedical Center, 2006-2007.22 Wyoming Nurse Reporter

Norman S. Holt AwardOliver Receives Awardfor Nursing ExcellenceMichelle Oliver, R.N., of Star ValleyCare Center (SVCC), received theprestigious Norman S. Holt Award forNursing Excellence at the 65th annualWyoming Hospital Association AnnualMeeting and Convention.Since 1999, Oliver has been theDirector of Nursing at SVCC, a 24-bed intermediate care facility knownthroughout Star Valley as an excellentJan Ross joined the Wyoming StateBoard of Nursing in September of 2010 asLegal Assistant. Jan brings with her over25 years of paralegal experience. Shegraduated from Kansas State Universityin 2009 with a Master’s Degree inFamily Studies and Human Services.In addition, she has Bachelor’s andAssociate’s Degrees in Criminal Justice.Jan is married and she and her husbandshare three daughters, two sons, andfour grandchildren. Jan enjoys Rockies’baseball games, camping, reading, andattending her youngest son’s baseballand basketball games.StaffMemberSpotlightPatti Hefflin, BSN, RN is oneof the Compliance Consultantsfor WSBN. She investigatescomplaints that are receivedagainst nurses. She assistedwith the development of andcurrently manages the NurseMonitoring Program (NMP). TheNMP accepts nurses with opencomplaints and those who havefinal board orders for a conditionallicense for substance use disorders.facility that delivers excellent care.SVCC was listed by CMS as a 5 StarFacility and received a deficiency-freerating in 2009 from the state Departmentof Health.The award was established in 1983 bythe WHA Board of Directors in honorand memory of Norm Holt because ofhis tremendous understanding and activeinvolvement with the nursing profession.The award is presented annually atthe WHA Convention to honor oneoutstanding nurse in Wyoming.Oliver’s nomination for the awardcited her tireless efforts to train, hire, anddevelop CNAs, her speaking engagementsthroughout the community on clinicaltopics, and her ability to stimulate youngpeople to pursue nursing as a career.Additionally, the nominationhighlighted her commitment to theresidents of SVCC. In one case, Olivertraveled two hours to sit with a residentwho had been transferred to a tertiary carefacility. Oliver stayed until the resident’sgranddaughter was able to arrive.Oliver received a complimentaryregistration to the WHA convention, aplaque, and a monetary award.BoardMember SpotlightMarguerite Herman, 60, is the consumerrepresentative on the WSBON, and she designedthe board’s log.She moved to Cheyenne in 1980 as anewswoman for The Associated Press, and shecontinues work as a free-lance journalist for severalorganizations. Marguerite has degrees in Englishliterature, education and journalism and lobbiesthe Wyoming Legislature for the League of WomenVoters, The Wyoming PTA and other clients.She is a long-time advocate for schools,breastfeeding and healthcare. She serves on the boards for the WyomingPTA, COMEA House homeless shelter, Wyoming Breastfeeding Coalitionand Cheyenne Schools Foundation. She is also a coordinator for WyomingHigh School Mock Trial.Marguerite has been married for 26 years to George Powers, a Cheyenneattorney, and she has three children: Rosemary, 24; Charlotte, 22; andTom, 20.Wyoming Nurse Reporter 23

y Janelle HoemDiet, Exercise and AttitudeHow I Changed My Lifetoo young to not worry aboutmy underlying cardiovasculardisease. After three months ofstarvation and a minimal attemptat increasing my exercise, my labvalues did not change and I wasplaced on medication.Just a year after the death ofmy brother and my mother fromcholesterol medication, it was discoveredthat my fasting blood sugar was abovenormal limits for several months in a row.Due to this increase, my family physicianordered an oral glucose tolerance testwhich I failed miserably. I was diagnosedwith Type II Diabetes. Needless to say Iwas devastated. As a nurse I knew whatDiabetes meant. This is when I decided to“....I decided not to become a victimto Diabetes.”Hoem, with her nieces, before her lifechangingregimenFor most of my life I’ve consideredmyself a healthy person. Asa child I was a competitivegymnast until a knee injury ended mygymnastics career. Even after surgeryand rehabilitation, I was involved withdancing as a teen and as a young adultI participated in city recreational sportslike softball and volleyball.As with most married women in theirtwenties, I started to put on a few poundsafter each of my two children. I wasnot extremely overweight but neededto reduce my weight by the few poundsthat I found after each of my pregnancies.During this time I also had a monsterrearing its ugly head called family genetics.Thanks to the Wyoming Health Fairsand my current employer (during this timeI had yet to attend nursing school), at age28 I found out that I had high cholesteroland high triglycerides. With instructionfrom my family physician I tried to adjustmy diet, and increase my exercise. I wasyoung and I had nothing to worry about.Just a year later my older brother suddenlypassed away of a myocardial infarction atage 39. To say the least, I no longer feltHoem, now, with her daughter Gracie KayCOPD, I started my journey to becomea nurse. During that journey I gaineda few more pounds and was the biggest Ihad ever been at 162 pounds. At five feetthree inches tall, coupled with my weight,that put my Basic Metabolic Index (BMI)in the overweight category. Through theassistance of floor nursing at CheyenneRegional Medical Center, I lost some ofthe weight I had put on in college butwas a constant 154 pounds (my BMI wasstill considered overweight) for manyyears. Then the genetics monster rearedagain. Due to consistent lab draws for mynot become a victim to Diabetes. I tooka step back and looked at what changesI needed to make to my life.I stopped thinking that my workoutregimen was sufficient. I joined a localgym and met with a fitness trainer fordirection. I now exercise three to fivetimes a week, faithfully. I combinerunning together with weight andstrength training. I have made a goalfor myself to run in a 12K race in Mayof 2011, and am well on my way toobtaining it. My stamina has increasedand I can now run five miles, whichis close to the 6.2 miles needed forthe race. My diet has also changeddrastically also. I concentrate on fooditems that are better for my diagnoses. Ioccasionally splurge outside my 10 gramfat and 30 gram carbohydrate meal butinclude an extra 30 minute workout to myweek to make up for my faults.Due to my changes in diet and exercise,my stress levels from working in nursinghave reduced, I have lost 25 pounds andmy BMI is now within normal limits.My hemoglobin A1c, triglycerides andcholesterol are all normal and I feelabsolutely amazing!Janelle Hoem is a Registered Nurseworking in the Emergency Departmentat Cheyenne Regional Medical Center,Cheyenne, Wyoming.24 Wyoming Nurse Reporter

Customer Service CornerWelcome to our premier Customer Service Corner feature! Inour ongoing attempts to improve customer service, the WSBN savedover 200 license and certificate holders a significant sum of moneythis past year. Several applications were received for new licensesand certificates in August and September. With the timing ofrenewals, these applicants would have had to renew their license orcertificate again by December 31, 2010. Rather than simply issuingthese licenses and certificates, our Licensing Coordinators contactedeach applicant and gave them the choice to receive their license orcertificate immediately upon receipt of the application, or hold offuntil October 1, 2010 so that they would only have to pay one fee.Over 200 applicants chose to wait, thereby saving themselves therenewal fee. Every one of those 200+ applicants was issued a licenseor certificate first thing on the morning of Friday, October 1st!How many licensees do we assist? In the third quarter of 2010,WSBN’s Licensing Coordinators handled over 1900 phone calls andwalk in customers. We received 533 applications for licensure orcertification; 530 licenses and certificates were issued in that 3-monthtime frame.After processing over 16,000 renewals last quarter, WSBN wantsto thank those who were able to use the online process and help useliminate paper from the process. If you had difficulties with yourrenewal, we have heard you. Please allow us to learn from theseexamples and make the changes necessary to smooth out the processin the future.Please remember, you will not receive a paper copy after yourenew. Your license status can be verified on our webpage by you oryour employer 24 hours a day, 7 days a week.Please feel free to contact Amanda Roberts at arober@wyo.gov foryour suggestions and feedback on customer service at WSBN.It’s nottoo late torenewLicense Renewal deadline isDecember 31st. But if you are runningbehind, don’t despair. There is a 30day grace period until March 1st -however, a late fee of $35 will applyto any renewal received after midnighton 12/31. Renewals later than March1st will be denied and an entire newapplication must be submitted completewith background check. Hard to makepayment online? Submit your renewaland mail us a money order for thefee. LPNs....you don’t need to haveIV therapy to renew your license. GetIV certified later but renew now. Andeveryone remember, it will happenagain in another 2 years so keep track ofyour education hours.Wyoming Nurse Reporter 25

Disciplinary ActionsGrounds for discipline for Licensed PracticeNurses and Registered professional Nursesare located in the Administrative Rules andRegulations Chapter 3 pages 3-12 through 3-13and Certified Nursing Assistants Chapter 7, pages7-8 and 7-9 (June 2009).Grounds for Discipline are: (i) engaging inany act inconsistent with uniform and reasonablestandards of practice, including but not limitedto: (A) Fraud and deceit including, but notlimited to, omission of required informationor submission of false information written orverbal; (B) Performance of unsafe client care;(C) Misappropriation or misuse of property; (D)Abandonment; (E) Abuse, including emotional,physical or sexual abuse; (F) Neglect, includingsubstandard care; (G) Violation of privacy orconfidentially in any form, written, verbal ortechnological; (H) Drug diversion-self/others;(I) Sale, unauthorized use, or manufacturing ofcontrolled/illicit drugs; (J) criminal conviction;(K) unprofessional conduct; (L) Boundaryviolations, including sexual boundaries; (M)Failure to comply with reasonable requests fromthe board including, but not limited to: (I)Responses to complaints; (II) Responses to formalpleadings such as notice of hearing and/or petitionand complaint; (III) Responses to requestsregarding application and/or renewal information(IV) Written response to request for explanationfor failure to disclose required information; (V)Failure to appear at properly noticed hearings;(N) Impairment. (I) lack of nursing competence;(II) Mental illness; (III) physical illness including,but not limited to, deterioration through the agingprocess or loss of motor skills; or (IV) chemical oralcohol impairment/abuse. (ii) Failure to conformto the standards of prevailing nursing practice, inwhich case actual injury need to be established.JACKSON, RAMAH CNA 9170 VOLUNTARY SURRENDERRamah Jackson, CNA, agreed to voluntarily surrender her nursing assistant certificate on July 8, 2010. At the time Ms. Jackson’s certificatewas issued, she was issued a Letter Awareness related to a disclosed history of criminal conviction, chemical dependency and treatment.Subsequently, Ms. Jackson was alleged to have stolen personal property from residents at a nursing home under her care. Ms. Jacksonentered a guilty plea to the criminal charges. Such conduct was alleged to have failed to conform to nursing standards and to have been amisappropriation of property. Ms. Jackson did not dispute the findings of the WSBN and, accordingly, Ms. Jackson agreed to voluntarilysurrender her CNA certificate.MARY REESE (DECEASED) RN 20557 CONDITIONAL LICENSEMary Reese, RN, entered into a Settlement Agreement, Stipulation and Order for a Conditional License on July 8, 2010. It was alleged that Ms.Reese suffered a Level III relapse while in the Wyoming Professional Assistance Program (“WPAP”). The terms of the ConditionalLicense required Ms. Reese to: (1) enroll in the Nurse Monitoring Program (“NMP”) for not less than sixty (60) months; (2) submitto random drug screens; (3) regularly attend AA or NA meetings, and submit documentation of such attendance to the NMP; (4) notsign out, dispense or administer controlled substances without direct supervision for at least twenty-four (24) months; (5) obtain aworksite monitor; (6) provide an annual report regarding her progression and education in recovery; (7) provide semi-annual clinicalsubstance abuse evaluation; (8) provide the terms of the conditional license to future employers; and (9) complete courses in professionalaccountability, ethics, and critical thinking.SCHMIDT, LUCILLE CNA 19953 LETTER OF REPRIMANDLucille Schmidt, CNA, entered into a Settlement Agreement, Stipulation and Order for a Letter of Reprimand on July 8, 2010. Ms. Schmidtwas alleged to have become intoxicated and involved in an altercation, in which Ms. Schmidt held a knife to another person’s neck.Subsequently, Ms. Schmidt entered a guilty plea to reckless endangerment. In light of Ms. Schmidt’s cooperation with the investigation,and other mitigating circumstances, the WSBN agreed to issue a Letter of Reprimand to her conduct and to recommend Ms. Schmidtcomplete a course in ethics.CARTER, NATALIE RN 24048 VOLUNTARY SURRENDERNatalie Carter, RN, agreed to voluntarily surrender her registered nursing license on July 8, 2010. It was reported by Ms. Carter’s employer thather declining performance and her failure to monitor the condition of a patient in her care led in part to the patient’s death. Ms. Carterwas terminated from her employment based upon failures to recognize the decline in the patient’s condition, do an appropriate assessment,accept the validity of the patient’s family’s concerns, recognize the patient was not on the monitor as well as questionable documentationin the patient’s charting. Such conduct was alleged to have failed to conform to nursing standards and to constitute fraud and deceit innursing practice. Ms. Carter subsequently agreed to voluntarily surrender her registered nursing license.FARINELLI, TRACY RN 25032 LETTER OF REPRIMANDTracy Farinelli, RN, entered into a Settlement Agreement, Stipulation and Order for a Letter of Reprimand on July 8, 2010. In July of 2009,Ms. Farinelli was issued a Conditional License by the Colorado BON, which included, among other things, a requirement for Ms.Farinelli to participate in a Peer Assistance Program. Ms. Farinelli generally admitted to having had issues with alcohol abuse andcommitment to sobriety. Ms. Farinelli is alleged to have failed to disclose criminal convictions on her Wyoming renewal application for herregistered nurse license for the 2008-2010 biennium. In light of Ms. Farinelli’s cooperation with the investigation, and other mitigatingcircumstances, the WSBN agreed to issue a Letter of Reprimand to her conduct and recommend a course in ethics.26 Wyoming Nurse Reporter

WILSON, SARAH RN 26682 LETTER OF REPRIMANDSarah Wilson, RN, entered into a Settlement Agreement, Stipulation and Order for a Letter of Reprimand on July 8, 2010. Ms. Wilson was allegedto have given a patient the wrong medication and not report the incident to her employer. Ms. Wilson admitted the allegations and furtheradmitted to changing documentation in the patient’s chart. Such conduct is alleged to have failed to conform to nursing standards and toconstitute fraud and deceit. However, in light of Ms. Wilson’s cooperation with the investigation and other mitigating circumstances, theWSBN agreed to issue a Letter of Reprimand and recommend a course in ethics.KING, WENDY APRN 18437.722 CONDITIONALWendy King, APRN, entered into a Settlement Agreement, Stipulation and Order for a Conditional License on July 30, 2010. Ms. King wasalleged to have questionable and/or excessive prescribing practices. The terms of the Conditional License require Ms. King to: (1)complete the terms of the conditional license within eighteen (18) months; (2) complete one of three options for continuing educationcourses; (3) obtain approval of the WSBN prior to enrolling in any courses; and (4) inform the WSBN of any address and/or telephonechange within five (5) days of such change.JOBE, MELANIE (MARTIN) APRN 27454.1008 LETTER OF REPRIMANDMelanie Jobe (Martin), APRN, entered into a Settlement Agreement, Stipulation and Order Staying Suspension of Prescriptive Authority and forLetter of Reprimand on July 8, 2010. Ms. Jobe was alleged to have written prescriptions for controlled and non-controlled substancesunder the name, license and DEA number of another APRN working in the same facility. In light of Ms. Jobe’s cooperation in theinvestigation and mitigating circumstances, the WSBN agreed to a stay of suspension of her prescriptive authority and a Letter ofReprimand for her conduct and to recommend Ms. Jobe complete courses as follows: (1) ethics, professional accountability, and sharpeningcritical thinking; (2) obstetrics refresher course; and (3) pharmacology course specifically for advance practice nurses.MARTIN, AHLEA RN 25101 CONDITIONALAhlea Martin, RN, entered into a Settlement Agreement, Stipulation and Order for Conditional License on September 23, 2010. Ms. Martin wasalleged to have been chemically impaired and diverting controlled substances, as well as test positive for opiates in a drug screen requestedby her employer. Ms. Martin generally admitted such allegations by her self-disclosure of use of opiates and the theft of a sharps container.Ms. Martin subsequently entered inpatient treatment. The terms of the Conditional License require Ms. Martin to: (1) enroll in theNurse Monitoring Program (“NMP”) for not less than sixty (60) months; (2) submit to random drug screens; (3) regularly attend AA orNA meetings, and submit documentation of such attendance to the NMP; (4) not sign out, dispense or administer controlled substanceswithout direct supervision for at least twenty-four (24) months; (5) obtain a worksite monitor; (6) provide an annual report regardingher progression and education in recovery; (7) provide semi-annual clinical substance abuse evaluation; (8) provide the terms of theconditional license to future employers; and (9) complete courses in professional accountability, ethics, and critical thinking.BHUTTO, NINA RN 20556 VOLUNTARY SURRENDERNina Bhutto, RN, agreed to voluntarily surrender her registered nurse license on September 24, 2010. It was alleged by Ms. Bhutto’s employershe was an impaired practitioner, had obtained a fraudulent prescription by using the identity of a patient for whom she was providingcare, and then diverting the prescription for her own personal use. Ms. Bhutto was charged with eight felony counts in Natrona CountyDistrict Court. As a result of a plea bargain agreement, Ms. Bhutto subsequently entered deferred guilty pleas to four of the original eightfelony counts. Accordingly, Ms. Bhutto agreed to voluntarily surrender her license.BROWN, ROSE RN 26459 VOLUNTARY SURRENDERRose Brown, RN, agreed to voluntarily surrender her registered nurse license on September 23, 2010. Ms. Brown was issued a conditional licenseby the Texas BON on or about October 2, 2009. Specifically, the Texas BON determined Ms. Brown posed a serious risk to public safetyfrom impaired nursing care resulting from the use of marijuana on a repeated basis. Specifically, Ms. Brown tested positive for marijuanain 1992 while working in Amarillo, Texas. In addition, Ms. Brown had two positive drug screens for marijuana—in June 2007 andAugust 2008—while working in Boca Raton, Florida. The Texas Conditional License included a requirement for participation in theTexas Peer Assistance Program for Nurses. Ms. Brown submitted an application to the WSBN, which was received by the WSBN onOctober 22, 2009, but did not disclose information relating to the Texas discipline. Ms. Brown subsequently did not dispute the findingsof the WSBN and, accordingly, agreed to voluntarily surrender her license.BURNHAM, HEATHER RN 28014 SUMMARY SUSPENSIONHeather Burnham, RN, stipulated to an Order for Summary Suspension on September 23, 2010. On or about August 12, 2010, the WSBNreceived a Stipulation and Final Agency Order from Colorado BON, which was based upon Ms. Burnham’s admissions of drug diversion,failure to comply with professional peer assistance requirements, and a pending criminal action involving possession of a controlledsubstance. Ms. Burnham failed to disclose the Colorado discipline when applying for a registered nurse license in Wyoming. This failureto comply led to a stipulation between Ms. Burnham and the WSBN to summarily suspend her registered nursing license pending furtherproceedings by the WSBN.Continued on page 28Wyoming Nurse Reporter 27

EWEN, JEROLD LPN 5593 VOLUNTARY SURRENDERJerold Ewen, LPN, agreed to voluntarily surrender his practical nurse license on September 23, 2010. In 2009 Mr. Ewen entered a 28-dayresidential treatment program following the loss of his job due to an addiction to opioids and benzodiazepines. After completing theresidential treatment and a year of outpatient treatment, Mr. Ewen enrolled in the Wyoming Professional Assistance Program. Mr. Ewenhas not returned to nursing practice nor does he intend to do so. Accordingly, Mr. Ewen voluntarily surrendered his practical nurselicense.HERRMANN, SUSAN RN 20499 VOLUNTARY SURRENDERSusan Herrmann, RN, agreed to voluntarily surrender her registered nurse license on September 23, 2010. Ms. Herrmann was issued a ConditionalLicense in 2009, arising from admissions of drug diversion and chemical dependency in July 2006. In August of 2006, Ms. Herrmannenrolled in the Wyoming Professional Assistance Program (“WPAP”). In February 2010 it was reported that Ms. Herrmann violated theterms of her monitoring agreement. Ms. Herrmann moved to West Virginia and agreed to voluntarily surrender her license.KIMBALL, JACQUELINE LPN 7457 LETTER OF REPRIMANDJacqueline Kimball, LPN, entered into a Settlement Agreement, Stipulation and Order for a Letter of Reprimand on September 23, 2010. Ms.Kimball was alleged to have not performed blood sugar tests on residents at a nursing home under her care, as well as enter false orincorrect information in medical charts or records regarding the results of the glucose tests. Although Ms. Kimball denied the allegations,an internal audit performed by the nursing home confirmed Ms. Kimball had not performed the indicated glucose tests, made false/incorrectdocumentation in medical chart/client records, and misrepresented nursing tasks that a patient subsequently confirmed had not been done.In light of Ms. Kimball’s cooperation with the investigation and mitigating circumstances, the WSBN agreed to a Letter of Reprimand andto recommend Ms. Kimball complete courses in ethics, professional accountability and legal liability, and critical thinking skills.RIDING, CATHERINE RN 19539 CONDITIONALCatherine Riding, RN, entered into a Settlement Agreement, Stipulation and Order for Conditional License on September 23, 2010. Ms. Ridingself-reported a DUI conviction in July 2009. The terms of the Conditional License require Ms. Riding to: (1) enroll in the NurseMonitoring Program (“NMP”) for a minimum of three (3) years; (2) obtain a worksite monitor; (3) provide an annual report to theWSBN on her progression; (4) provide the terms of the conditional license to future employers; (5) complete courses in ethics andprofessional accountability; and (6) undergo monthly alcohol and drug screening.SCHWEDA, KELLY ROBINSON RN 14072SUMMARY SUSPENSIONKelly Robinson Schweda stipulated to an Order for Summary Suspension on September 23, 2010. Ms. Schweda was issued a Conditional Licensefor her conduct related to substance abuse. Such Conditional License required Ms. Schweda to enroll in the Wyoming ProfessionalAssistance Program (“WPAP”) and/or the Board’s Nurse Monitoring Program (“NMP”). Ms. Schweda was reported to have violated theterms of her monitoring agreement. This failure to comply with her Conditional License led to a stipulation between Ms. Schweda and theWSBN to summarily suspend her registered nursing license pending further proceedings by the WSBN.UNDERWOOD, CONSTANCE RN 15597 VOLUNTARY SURRENDERConstance Underwood, RN, entered into a Settlement Agreement, Stipulation and Order for Voluntary Surrender on September 23, 2010. Ms.Underwood was issued a Conditional License in January 2010 for her conduct related to substance abuse. Such Conditional Licenserequired Ms. Underwood to participate in the Wyoming Professional Assistance Program (“WPAP”). In June 2010 Ms. Underwood wasreported to have violated the terms of her conditional license. Accordingly, Ms. Underwood agreed to voluntarily surrender her license.Denials of Applicants Seeking Licensure or CertificationThe Nurse Practice Act, 33-21-146 identifies the following reasons that an application may be denied:“(a) The board of nursing may refuse to issue or renew, or may suspend or revoke the license, certificate or temporary permit of anyperson, or to otherwise discipline a licensee, upon proof that the person:(i) Has engaged in any act inconsistent with uniform and reasonable standards of nursing practice as defined by board rules andregulations;(ii) Has been found guilty by a court, has entered an Alford plea or has entered a plea of nolo contendere to a misdemeanor orfelony that relates adversely to the practice of nursing or to the ability to practice nursing;(iii) Has practiced fraud or deceit:(A) In procuring or attempting to procure a license to practice nursing;(B) In filing or reporting any health care information, including but not limited to client documentation, agency recordsor other essential health documents;(C) In signing any report or record as a registered nurse or as a licensed practical nurse;(D) In representing authority to practice nursing; or(E) In submitting any information or record to the board.28 Wyoming Nurse Reporter

(iv) Is unfit or incompetent to practice nursing by reason of negligence, habits or other causes including but not limited to:(A) Being unable to practice nursing with reasonable skill and safety to patients by reason of physical or mentaldisability, or use of drugs, narcotics, chemicals or any other mind-altering material; or(B) Performance of unsafe nursing practice or failure to conform to the essential standards of acceptable and prevailingnursing practice, in which case actual injury need not be established.(v) Has engaged in any unauthorized possession or unauthorized use of a controlled substance as defined in the WyomingControlled Substances Act [§§ 35-7-1001 through 35-7-1057];(vi) Has had a license to practice nursing or to practice in another health care discipline in another jurisdiction, territory orpossession of the United States denied, revoked, suspended or otherwise restricted;(vii) Has practiced nursing within this state without a valid current license or temporary permit or as otherwise permitted underthis act;(viii) Has knowingly and willfully failed to report to the board any violation of this act or of board rules and regulations;(ix) Has been found by the board to have violated any of the provisions of this act or of board rules and regulations; or(x) Has knowingly engaged in an act which the licensee knew was beyond the scope of the individual’s nursing practice prior tocommitting the act, or performed acts without sufficient education, knowledge, or ability to apply nursing principles andskills; or(xi) Has failed to submit to a mental, physical or medical competency examination following a proper request by the board madepursuant to board rules and regulations and the Wyoming Administrative Procedure Act.(b) Upon receipt from the department of family services of a certified copy of an order from a court to withhold, suspend or otherwiserestrict a license issued by the board, the board shall notify the party named in the court order of the withholding, suspension or restrictionof the license in accordance with the terms of the court order. No appeal under the Wyoming Administrative Procedure Act shall beallowed for a license withheld, suspended or restricted under this subsection” (pg 12-13 of 18).DENIALS OF APPLIANTS SEEKING LICENSURE OR CERTIFICATIONMCCOLLUM, JAMESCNA APPLICANTMr. McCollum’s application for certification as a CNA was denied by the WSBN application review committee due to his multiple criminalconvictions. He is currently on probation as of this date and will not be released until December, 2011.Wyoming Nurse Reporter 29

Gems Worth Sharing...Pearls of PracticeEveryone has a nursing secret…..a special method of doingsomething they learned along the way from another nurse, a mentor,a clinical instructor or by trial and error. It might be evidence basedpractice or an old “nurses” tale, but if it works and makes things easierfor you or your patient the WSBN is interested in hearing from YOU.Any CNA, LPN, RN, or APRN can submit. Send in your Pearls ofPractice to wynursing@state.wy.us and if selected for publication youwill receive a special gift.Starting off this feature are a few from the archives:Bath Blanket pull up: always put a bath blanket lengthwise onthe seat and up the back of a chair. When the patient starts slidingdown in the chair the blanket provides a perfect pullup for one personand gets their bottom back into the seat.Chlorhexadine Scrub: Gone are the days of the concentric circleskin prep. Chlorhexadine is proven more effective than betadine asa skin prep disinfectant. It is meant to be used with a back and forthscrubbing motion for 30 seconds. Its antibacterial properties includethe breakdown of the cell wall and the scrubbing motion helps breakthem apart.Warm Hands: Next time you are doing your PM cares and youwant to give a back rub, try this. Put a little lotion on your palms thenclap your hands together very hard and immediately rub your palmsback and forth vigorously. Doing this several times will generate alot of heat and when you place your palms on the patient’s back theheat will help relax their muscles. Warn them before you clap or youcould startle them.Upside down Back Rub: Got a patient on strict bedrest after aprocedure? Slide your hands under the small of their back with yourpalms up. Now use your finger tips to massage the muscles on eitherside of the spine. Work your way up to areas of discomfort and yourpatient will think you are a genius.Nose Anchor: NG tubes can be tricky to secure and the patientlooks terrible having a big tape strip on their face. If you have thesmall tegaderm dressings they work great. They stick great to thenose without tearing the skin and since they are invisible they areless obvious to the patient (who can always see the white tape ontheir nose). Just overhang a little off the tip of the nose and wrap thisaround the NG tubeNurse NetworkingThe “NEW” ClassifiedsReach 11,000 nurses in Wyoming for as little as $325.limitedavailabilityCALL TODAYContact Victor Hornevhorne@pcipublishing.com1-800-561-4686 ext. 114WyomingPQRST(Practice QuestionsRequiring SubstantialThought)NurseVol. 6 number 4 Winter 2010R E P O R T E RDiet, Exercise and AttitudeHow I CHanged My LIfeIt’s nottoo Lateto renewsee page 11By Jeannette HoemWork in Comfort!Your Wyoming source for scrubs, footware, compression hosiery and more!Great assortment, multiple brand lines.www.cherokee-kimberlysuniforms.com(307) 235-3156 Visit www.KimberlysUniforms.com1632 East 2nd St.. Casper, Wy 82601Text “scrubs”to 91011 forexclusivesoffersNursing ProgramAdministratorsRecruit NursingFaculty HereVictor Horne(800) 561-4686 ext. 114The Perfect Gift!Roscoe Possum MeetsNurse QuackerDebi Toporoff, D. Min., RN, is an awardwinning author, nurse and motivationalspeaker. View her entire series of heartwarmingand life enriching books atwww.VisionaryMinistries.comOrder from Amazon.com, Books-a-Million.com and your local book retailer. Toreceive a signed HB copy, send $15.99(shipping incl) to Dr. Debi Toporoff, POBox 25, Gloverville, SC 29828.30 Wyoming Nurse Reporter

Sixth AnnualNursing Continuing EducationCruiseApril 10-17, 2011ARUBACruise your way toNursing CE CreditsCEThinkNurse.comCRUISEThinkNurse.comon the Caribbean Sea aboardAdventure of the Seas!Day Port Arrive Depart Activity10-Apr San Juan, Puerto Rico 8:30 PM11-AprCruising12-Apr Willemstad, Curacao 8:00 AM 6:00 PM Docked13-Apr Oranjestad, Aruba 8:00 AM 6:00 PM Docked14-AprCruising15-Apr Roseau, Dominica 8:00 AM 5:00 PM Docked16-Apr Charlotte Amalie, St. Thomas 8:00 AM 6:00 PM Docked17-Apr San Juan, Puerto Rico 6:00 AMWho said Continuing Education can’t be fun? We are changing that forever. JoinThinkNurse and Poe Travel for a CE Cruise that will cure your overworked blues with some salsaand sun on Royal Caribbean’s Adventure of the Seas. While you’re touring the Caribbean, you canearn your annual CE credits AND possibly write the trip off on your taxes. How is that for paradise?Prices for this cruise and conference are based on double occupancy (bring your friend, spouseor significant other please!) and start as low as $848 per person (not including airfare). If youwon’t be attending the conference, you can deduct $75. A $250 non-refundable per-person depositis required to secure your reservation for the cruise, BUT please ask us about our CruiseLayAway Plan.What a week! We depart from San Juan, Puerto Rico. Your first stop is Willemstad, Curacao.Our next stop is Oranjestad, Aruba, then Roseau, Dominica, and Charlotte Amalie, St. Thomasbefore cruising back to San Juan.For more information about the cruise and the curriculum, pleaselog on to our Web site at ThinkNurse.com or call Teresa Grace atPoe Travel Toll-free at 800.727.1960.

Wyoming State Board of Nursing1810 Pioneer Ave.Cheyenne, Wyoming 82002Presorted StandardU.S. Postage PaidLittle Rock, ARPermit No. 1883MAKE A NEW YEAR’S RESOLUTIONTO TALK ABOUT COLORECTAL CANCER IN 2011Wyoming Public Health Nurses talk to patients aboutthe importance of screening for colorectal cancer.As a nurse, you are in a unique position to influencebehavior that can change lives. From this perspective,we are all public health nurses.Colorectal cancer is preventable, treatable, beatable!Start talking! Keep talking!Crystal Smith, RN, CLCJohnson County Public HealthBuffalo, WYSave a life in 2011!Free colonoscopies are available toeligible Wyoming residents.Be a hero.Save a life.Merrillee Francom R.NUinta County Public HealthEvanston, WYGail VanderPloeg, LPNBig Horn County Public HealthTO APPLY FOR A FREE COLONOSCOPYCall 1-866-205-5292or visit https://ccedp.health.wyo.govJan Hubenka, RNFremont County Public HealthLander, WY