The North Dakota Nurse - February 2017

The North Dakota Nurse
NORTH DAKOTA NURSES ASSOCIATION
INDEX
THE OFFICIAL PUBLICATION OF THE NORTH DAKOTA NURSES ASSOCIATION
Sent to all North Dakota Nurses courtesy of the North Dakota Nurses Association (NDNA). Receiving this newsletter
does not mean that you are a member of NDNA. To join please go to www.ndna.org and click on “Join.”
Quarterly publication direct mailed to approximately 16,000 RNs and LPNs in North Dakota
Vol. 86 • Number 1 February, March, April 2017
President’s Message
Healthy Nurse, Healthy Nation
NDNA Present at
ANA’s Leadership Summit
Page 2
North Dakota’s 62,100 Family
Caregivers Need Our Support
Page 11
Healthy Nurse Healthy Nation
Grand Challenge
Page 13
Tessa Johnson, MSN, BSN, RN, President NDNA
Greetings nurses of North Dakota; it is my
pleasure to welcome you all to the first 2017 edition
of the North Dakota Nurse. It has been an honor to
serve as the VP for membership services for NDNA
and I’m so excited to be your NDNA president
for the 2017-2018 term! I would like to personally
thank all nurses who attended our Culture of
Safety conference and annual meeting in October; it
was a huge success. With that in mind, stay tuned
for more upcoming conferences and events!
As we begin another new year many of us have
new goals, resolutions and plans for our personal
and professional lives. The question that I am
certain most professional nurses ask themselves is,
“How do I find the balance to keep myself healthy
in order to uphold my nursing code of ethics and
keep my patients and my nation healthy?” Being
a nurse is only one of our primary roles in life
and many of us are parents, friends, siblings and
leaders along with wearing many other hats.
According to Lachman, Swanson and Windland-
Brown (2015), “The nurse owes the same duties
to self as to others, including the responsibility
to promote health and safety, preserve wholeness
of character and integrity, maintain competence,
and continue personal and professional growth”
(p.364). With that being said it is important for us
as professional nurses to prioritize our needs and
have a healthy work-life balance.
Being a mother and a nurse leader, I also
over-commit myself and take on too much. We are
the type of people who have a hard time saying
no and we want to help as much as we can. I
challenge you to think about what it means for
you to be a healthy nurse. I challenge you to think
SAVE THE DATE
of ways you can ensure
your mind, body and spirit
remains healthy. This will
ensure that you can give
100% to your patients and
help create a healthy nation.
When I think about being
an all-encompassing healthy Tessa Johnson
nurse I think about many
things; minimizing burnout, exercise, healthy diets,
spiritual needs, and fostering personal relationships.
In the coming months we are lucky to have
this topic as a primary focus from ANA as well.
One thing I know for sure is that we are all in
this together. As nurses many of us face the
same challenges and care about the same issues.
We need to do our best to utilize each other,
maintain relationships, fight for being a healthy
nurse and a healthy nation. With many unknown
changes coming with our recent presidential
election, we know that our profession will face
more changes and additional work. My hope for
all the wonderful nurses in our state is to start
out this new year by prioritizing. We need to
prioritize our personal and professional lives and
make sure we know what is important. I ask you
to unite as a strong force and look out for each
other; get involved where you can and take care
of yourself always! North Dakota is lucky to have
great nurses who care about many issues and I
am excited to see what this year brings with new
changes, fresh leadership and a busy legislative
session! Be well, we need all of you!
1. Lachman, V. D., Swanson, E., & Windland-Brown,
J. (2015, September/October). The New ‘Code of
Ethics for Nurses. MedSurg Nursing, 363-368.
current resident or
Presort Standard
US Postage
PAID
Permit #14
Princeton, MN
55371
15 th Annual Northwest Region North Dakota
Collaborative Educational Conference
“NURSING PRACTICE IN CHAOTIC TIMES”
April 7, 2017 | Grand Hotel, Minot, ND
Provided by: District 1, North Dakota Nurses Association
Omicron Tau Chapter, STTI Honor Society of Nursing
Contact Hours: to be submitted to ND Board of Nursing
See Page 6

Page 2 The North Dakota Nurse February, March, April 2017
NDNA Present at ANA’s
Leadership Summit
“Aligning Leadership to Advance the Profession
of Nursing” is the theme of the American Nurses
Association Leadership Summit attended by
President-Elect Tessa Johnson and Executive
Director Carmen Bryhn. Topics included Effecive
Decision Making in an Over-Thinking World, Using
Strengths to Advance Leadership, Communication
and more! The Leadership Council collaborated
with ANA providing our input on several topics
including access to care in rural and under-served
areas, health system activity, Healthy Nurse,
Healthy Nation, ANA product development, optimal
nurse staffing and ANA’s policy development.
The 3 days in Washington DC were jam packed
with sessions full of information, networking,
and collaboration. We look forward to continued
discussion on these topics locally and nationally.
The North Dakota Nurse
Official Publication of:
North Dakota Nurses Association
General Contact Information:
President:
Tessa Johnson, MSN, RN
president@ndna.org
701-335-6376 (NDRN)
info@ndna.org
Carmen Bryhn, MSN, RN
Executive Director
director@ndna.org
Officers
Vice President–
Membership Services
Amanda Abrams, BSN, RN
amanda.kuntz@ndsu.edu
It’s a new year
with a new look.
Vice President–
Communications
Jacki Bleess Toppen,
MSN, PMHNP-BC
jacki.toppen@uhsinc.com
Vice President–
Government Relations
Kristin Roers
advocacy@ndna.org
Check out our new logo!
Welcome New
Members
Vice President–
Finance
Donelle Richmond
donelle.richmond@
gmail.com
Director at Large-
New Graduate
Joe Vetter, BSN, RN
joey.vetter@yahoo.com
Vice President–
Practice, Education,
Administration, Research
Sherry Burg, MBA, RN
sburg@altru.org
Cheryl Brant
Amanda Ellingson
Emily Stevens
Tamsen O’Berry
Molly Ecker
Deeanna Opstedahl
Kelley Amsbaugh
Courtney Mirera
Jessica Pigeon
Jessica Hammargren
Kari Jensen
Cindy Czapiewski
Kimberly Luster
Emily Buckingham
Mary Pat Holler Bibel
Sherline Oriental
Sarah Maack
Ali Church
Kelly Counihan
Julie Fuher
Mindy Ledene
Macy Martinson
Jennifer Vandal
Anna Friedt
National Diabetes Prevention Program (National DPP)
Help prevent or delay type 2 diabetes today:
screen and refer patients with PREDIABETES to the National DPP
What is the National DPP?
• Evidence-based lifestyle change program for adults
with prediabetes
• Helps prevent type 2 diabetes through a 5-7% weight
loss and 150 minutes of exercise per week
• See http://diabetesnd.org for local programs
• Medicare reimbursement is coming January 2018
Get Started Today!
• Screen people at risk for prediabetes and refer to a local
program: http://diabetesnd.org
• Have a question or want a program developed near
you? Contact: jmyers@nd.gov
Published quarterly: February, May, August and
November for the North Dakota Nurses Association, a
constituent member of the American Nurses Association,
1515 Burnt Boat Dr. Suite C #325, Bismarck, ND 58503.
Copy due four weeks prior to month of publication. For
advertising rates and information, please contact
Arthur L. Davis Publishing Agency, Inc., 517 Washington
Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-
4081, sales@aldpub.com. NDNA and the Arthur L. Davis
Publishing Agency, Inc. reserve the right to reject any
advertisement. Responsibility for errors in advertising is
limited to corrections in the next issue or refund of price of
advertisement.
Acceptance of advertising does not imply endorsement or
approval by the North Dakota Nurses Association of products
advertised, the advertisers, or the claims made. Rejection
of an advertisement does not imply a product offered for
advertising is without merit, or that the manufacturer lacks
integrity, or that this association disapproves of the product
or its use. NDNA and the Arthur L. Davis Publishing
Agency, Inc. shall not be held liable for any consequences
resulting from purchase or use of an advertiser’s product.
Articles appearing in this publication express the opinions of
the authors; they do not necessarily reflect views of the staff,
board, or membership of NDNA or those of the national or
local associations.
Writing for Publication in
The North Dakota Nurse
The North Dakota Nurse accepts manuscripts for
publication on a variety of topics related to nursing.
Manuscripts should be double spaced and submitted
electronically in MS Word to director@ndna.org. Please
write North Dakota Nurse article in the address
line. Articles are peer reviewed and edited by the RN
volunteers at NDNA. Deadlines for submission of
material for 2017 North Dakota Nurse are 3/13/17,
6/13/17, 9/13/17 and 12/13/17.
Nurses are strongly encouraged to contribute to the
profession by publishing evidence based articles. If you
have an idea, but don’t know how or where to start,
contact one of the NDNA Board Members.
The North Dakota Nurse is one communication
vehicle for nurses in North Dakota.
Raise your voice.
The Vision and Mission of the
North Dakota Nurses Association
Vision: North Dakota Nurses Association, a
professional organization for Nurses, is the voice of
Nursing in North Dakota.
Mission: The Mission of the North Dakota Nurses
Association is to promote the professional development of
nurses and enhance health care for all through practice,
education, research and development of public policy.

February, March, April 2017 The North Dakota Nurse Page 3
Join us for NDNA’s NURSES DAY AT THE LEGISLATURE
ON FEBRUARY 20TH, 2017 at the Capitol!
We will be holding this event on the morning of February
20th in conjunction with the Nursing Student Association
of North Dakota’s Annual Convention being held at the
Ramada, Bismarck. Have a voice in nursing policy and
attend this special event!
Students and all nurses welcome. Please register
online at ndna.org today! Deadline for registration is
February 13th.

Page 4 The North Dakota Nurse February, March, April 2017
2017-2018 Advocacy Platform
The North Dakota Nurses Association promotes
legislation, policies, and strategies that help meet
North Dakota’s most pressing needs.
• Support efforts to attract and retain more
nurses to the profession and to the state
(Workforce Development).
o Support efforts to improve Workforce
Development including improved Loan
Reimbursement, Faculty Loan Forgiveness,
and growth of Educational programs.
• Promote awareness and prevention of
Workplace Violence in healthcare settings
o Through legislation, develop broader
protections from violence for workers in
healthcare institutions.
o Support efforts to prevent Workplace
Violence including improved behavioral
health programs.
• Support Population Health focused legislation
and activities including, but not limited to,
Obesity Prevention & Treatment, Substance
Abuse Prevention & Treatment – including
drugs, alcohol and tobacco, Access to Behavioral
Health Services, and Access to Early Childhood
Preventative Interventions – including
increased access to School Nursing
• Support efforts to improve Behavioral Health
programs and assistance.
o Support improved education and increased
capacity for patient access.
o Develop evidence based interventions to
combat the growing opioid crisis.
• Collaborating with agencies such as American
Lung Association for decreased tobacco use.
o Tobacco is a worldwide epidemic that requires
the leadership and active involvement of nurses.
o All nurses and nursing organizations
are actively involved in developing and
supporting local, state, and national
legislative and regulatory efforts that:
• Restrict the direct and indirect
marketing of tobacco products, including
those products that might be launched in
the future, and those making unproven
health claims.
• Increase the price of tobacco products
through taxation and allocate part of the
revenue to tobacco-control programs and
tobacco-related research.
o North Dakota has the 48th lowest cigarette tax
of all 50 states and the District of Columbia.
State Tax per Pack Ranking
New York $4.35 1st
Minnesota $3.00 8th
Montana $1.70 21st
South Dakota $1.53 26th
Average $1.65
Wyoming $0.60 43rd
North Dakota $0.44 48th
Missouri $0.17 51st
• Advocating for increased access to School
Nursing.
o Students’ health and health needs must be
addressed in schools to achieve optimum
learning.
o Supports the assignment and daily
availability of a registered school nurse for
the central management and implementation
of school health services at the recommended
ratio of one nurse for every 750 students, with
an ultimate goal of at least one nurse in every
school (ANA, 2007).
o On any given weekday, as much as 20%
of the combined US population of children
and adults can be found in schools (AHA,
2004). To best serve the health needs of
students and staff in educational settings,
ANA supports a collaborative school health
model which requires the cooperation and
participation of the school nurse, students,
families, teachers, school administrators and
staff, other health care professionals, and the
community.
• Continue to advocate for increased access to
professional nursing education and Nurses
working in the full authority of their practice.
o Support higher education for nurses. We
need fundamental wide-range planning for
changes in the education and deployment of
the nursing workforce.
o Reduce regulatory barriers, enabling
Registered Nurses (RNs) to practice to the
full extent of their education and training.
Support compact licensure for Registered
Nurses and Advanced Practice Registered
Nurses (APRNs)
o Revise scope-of-practice laws that
discourage full use of advanced practice
nurses, pharmacists, and other allied
health professionals (collaborative practice
agreements, supervisory requirements,
prescribing limitations).
• Promote programs that support improved Care
Delivery across the state of North Dakota.
o Continue support of technologies, including
Telehealth to support expanded access to
services.
o Support new and evolving roles as long as
there is role clarity, appropriate education
and training, appropriate oversight and that
nurses are recognized for their role as care
coordinators, which may necessitate removal
of the delegation rules in the Nurse Practice
Act that limit nurses ability to exercise their
judgment.
• Collaborating in the study of the Community
paramedic pilot to ensure safe, gap free care.
o Support the educational programs to provide
nurses to educate Community Paramedics
o Support the development of the supervision
requirements to include primary care, rather
than emergency medicine
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February, March, April 2017 The North Dakota Nurse Page 5
Professor on the Prairie
What About Evidence Based Practice?
Trish Strom, BSN, M.Ed., RN, LPC, CNML
Assistant Professor of Practice
NDSU School of Nursing
A familiar construct in
nursing is to execute Evidence
Based Practice (EBP). So if
asked, what do you really
know about EBP? Nursing
students take two research
courses, and soon find out
the challenges in finding
EBP articles. As noted by
Finkelman and Kenner (2016),
nursing research is not as
far along in implementation
as medicine is. They further
state “The amount of nursing
Trish Strom
research must increase –
not just in quantity, but
also in quality and relevance to nursing practice”
(Finkelman & Kenner, 2016, p. 360). That being
said, who do you think would be able to identify the
most relevant topics to research related to nursing?
Of course I think it is professional nurses at the
bedside collaborating with other nurses, faculty, and
members of the multidisciplinary team.
Where does someone start to understand
Evidence Based Practice? The PICOT question is
an important step when searching for evidence
to improve practice. The aim is to pose questions
that you can search and find answers to identify
the best evidence in answering the question. The
PICOT acronym stands for patient/population,
intervention, comparison, outcome, and time
(Melnyk & Stillwater, 2010, pp. 29-30).
I thought the best way to illustrate this brief
lesson is to list the clinical questions posed by
North Dakota State University senior nursing
students in Dr. Shila Thompson’s research class. If
you are asking these same questions, email me at
trish.strom@ndsu.edu and I will send you their
abstract.
The Xi Kappa-at-Large Chapter of Sigma
Theta Tau International Honor Society for
Nursing held its annual induction ceremony on
Saturday, November 5, 2016 in Jamestown, ND.
The induction recognizes nursing students and
community nurse leaders who have demonstrated
achievements in nursing, leadership qualities and
high professional standards. Inductees consisted of
students from the following colleges:
• Concordia College: Leah Benthin, Brian
Bickel, Elizabeth Dorf, Emily Honl, Lauren
Lee, Megan Lindquist, Emily Luckhardt,
Katharine Serbus, Kayla Stanelle, and
Rachel Tolkinen
• Minnesota State University Moorhead:
Briana Powell and Melissa Mostad
• North Dakota State University Fargo: Amy
Andrushko, Anna Benke, Melinda Duenow,
Monica Flackey, Brooke Feltman, Leah
Hermanson, Hailey Kotts, Christian May,
Katie McCorquodale, Nicole McDonald,
Naomi Meier, Alexis Rankka, Jamie
Tollefson, Vesela Ugrinova, and Kari Ust
• North Dakota State University at Sanford
Health Bismarck: Bryce Anderson,
Hannah Bailey, Levi Barbao, Kendra
Beedy, Rebecca Bruns, Kayla Casteel,
Sohaila Dadelahi, Madison Deibert, Mary
Rounding Around the Clock
Appraised by: Naomi Meier, SN, Karin
Mortenson, SN, Darby Schmidt, SN, Kari Ust, SN.
Clinical Question: For patients in hospital
settings, does implementation of care rounding
programs affect falls, call light use, ulcers and
patient satisfaction?
Gettin’ Down and Dirty With CHG
Appraised by: McKenzy Davis SN, Christian
May SN, Bryon Schuldt SN, & Evan Wyum SN
Clinical Question: In hospitalized patients, how
does the implementation of Chlorhexidine Gluconate
(CHG) baths affect infection rates?
Tomorrow’s Prevention, Today
Appraised by: Anna Benke SN, Trisha Nelson
SN, & Katie Rice SN
Clinical Question: In diabetic patients, does
education intervention affect HbA1C levels or
glycemic control?
Impact of Nurse Residency Programs:
Job Satisfaction and Nurse Retention
Appraised by: Brooke Feltman, SN, Monica
Flackey, SN, Nicole McDonald, SN, Alesia Rankka, SN
Clinical Question: For newly graduated nurses,
how does participating in a nurse residency program
affect nurse retention and job satisfaction?
Effects of Early Ambulation in the Intensive
Care Unit (ICU)
Appraised by: Siennah Chistianson, SN,
Ciera Jacklitch, SN, Hailey Kotts, SN, Brianne
Wilkinson, SN
Clinical Question: With ICU patients, what
effect does implementing early mobility protocols
and program have on complications and days spent
in the ICU?
Closed-System Suction or Open-System
Suction: That is the question! How do they
affect the rates of VAP?
Dingman, Jordan Ebel, Oxana Flemmer,
Lindsey Kirschenheiter, Kelley Lehrke,
Lindsey Robinson, Ashlee Rudolf, Amber
Schmidt, Devyn Schmidt, Lauren Sneddon,
Taylor Stute, Kelsey Weigel, and Elizabeth
Wickenheiser
• University of Jamestown: Christine Coughlin,
Megan Cunningham, Brook Grooters,
Ashley Jenniges, Danette Larson, Christa
Lysne, Catherine Nienhaus, Kelsey Newton,
Alphonse Schoeneberger, Andrea Steinberger,
Shanda Stromley, Lauren Tollefson, and
Melissa Wilson
Community Nurse Leader inductees: Rhonda
Entzie, Paula Fogarty, Lisa La Fontaine, and
Patricia Wetzel
Scholarships were also awarded to the following
recipients:
• Xi Kappa Graduate Scholarship: Jaclyn
Johnson
• Xi Kappa Undergraduate Scholarships:
Sohaila Dadelahi, Hailey Kotts, and Nicole
McDonald
• Martha Vorvick Berge Scholarship: Brooke
Feltman
Congratulations to the new inductees and
scholarship recipients!
Appraised by: Ashton Buller, SN, Jenny
Guibert, SN, Anya Jones, SN Faith Mormon, SN
Clinical question: For hospitalized patients
on mechanical ventilation, how does closedsystem
suctioning compared to open-system
suctioning affect the rates of ventilator-associated
pneumonia?
Augmentative and Alternative Communication
for Suddenly Speechless Patients
Appraised by: Trevor Arrowsmith, SN, Oluchi
Okakpu, SN, Amanda Schmiesing, SN, Vesela
Urgrinova, SN
Clinical Question: What is the effect of
augmentative and alternative communication methods
on patients’ ability to interact with others?
Catching ZZA’s in the ICU
Appraised by: Austin Anderson, SN, Josie Carlson,
SN, Andrea Johnson, SN, Katie McCorquodale, SN
Clinical Question: For hospitalized patients,
how do nursing interventions during the night
affect the quality of sleep?
Truvada: The Pill to Prevent HIV Infection
Appraised by: Abby Astrup, SN, Hayli Bauer,
SN, Tom Clawson, SN, Jamie Tollefson, SN
Clinical question: For individuals at risk for
acquiring HIV, do education and perceived barriers
affect adherence to consistent use of Truvada for
HIV prophylaxis?
Wipe Off to Wipe out Bacteria
Appraised by: Colton Bruhn, SN, McKinsey
Heiser, SN, Dylan Maii, SN, Sharon White
Bear, SN
Clinical question: In healthcare workers,
does cleaning a stethoscope affect bacterial
contamination?
Hyperbaric Oxygen Therapy:
An Innovative Treatment for Chronic Wounds
Appraised by: MeLinda Duenow, SN,
Megan Rott, SN, Jaclynn Saunders, SN, Emily
Wassenaar, SN
Clinical question: In patients with chronic
wounds does hyperbaric oxygen therapy affect
wound healing?
Work Less for More: The Effects of Nursing Shift
Length on Patient Outcomes and Nurse Fatigue
Appraised by: Steven Condon, SN, Leah
Hermanson, SN, Nicole LaValle, SN, and Stephanie
Wall, SN
Clinical question: In Inpatient Registered
Nurses, does working 12 hours or more in a shift
affect nurse fatigue and patient outcomes?
References
Finkelman, A. & Kenner, C. (2016). Professional
Nursing Concepts: Competencies for Quality
Leadership. Burlington, MA: Joanes & Bartlett
Learning.
Melnyk, B. & Stillwater, S. (2010). Asking compelling,
clinical questions. In B. Melnyk & E. Fineout-
Overhot (Eds.), Evidence-based practice in nursing
and healthcare (pp. 25-39). Philadelphia, PA:
Lippincott Williams & Wilkins.
For consideration, apply to:
Bethany Retirement Living
Attn: Sina Sarabakhsh
201 S. University Dr., Fargo
701-239-3250 EOE
ssarabakhsh@bethanynd.org
www.bethanynd.org
RN/LPNs
Find out why we’ve been voted
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Bethany Retirement Living is now hiring
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employer-paid life insurance, and 401k
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requirement. Must be ND LPN or RN
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Page 6 The North Dakota Nurse February, March, April 2017
“Nursing Practice
in Chaotic Times”
April 7, 2017
8:15am – 3:30pm
The GRAND Hotel
1505 North Broadway
Minot, ND
Provided by:
District 1, North Dakota
Nurses Association and
Omicron Tau Chapter,
Sigma Theta Tau International
Honor Society of Nursing
Presenters
Eileen Weber, DNP, JD, PHN, BSN, RN
Clinical Assistant Professor
Population Health and Systems
School of Nursing, University of Minnesota
Virginia Beeson, BSN, MSN, NEA-BC
Captain, Nurse Corps, United States Navy
(retired), Educator & Consultant, Healthcare
Leadership Development
____________________________________________
Name
____________________________________________
Address
____________________________________________
City, State, Zip
____________________________________________
Phone
____________________________________________
Email
I am a Member of:
____ NDNA
____ Omicron Tau, STTI
I am interested in joining____________________
and would like membership information.
Food Allergies_____________________________
Registration Fee: (Includes Lunch)
____ $65.00 Non Members
____ $55.00 Members
____ $70.00 after March 28, 2017
____ $25.00 for students
(No refunds after March 28, 2017)
Please make checks payable to
Omicron Tau Chapter
Mail Registration and Fee to:
Mary Smith
C/O Dept. of Nursing, MSU
500 University Avenue West
Minot, ND 58707
Questions call 701-858-3251
Conference Planning Committee
Judy Beck RN, MSN
Sandy Boschee, RN, BSN
Susann DeForest RN, BSN, MS
Ashley DeMakis RN, BSN
Jamie Hammer RN, BSN, MSN
Mary Smith RN, BSN, MS
Heather Sys RN, BSN, MBA
7:45am – 8:15am
8:15am – 8:30am
8:30am – 9:30am
9:30am-10:30am
10:30-10:50am
10:50am-12:05pm
12:05-1:00pm
1:00pm-2:00pm
2:00-2:15pm
2:15pm-3:15pm
3:15-3:30pm
Agenda
Registration
Welcome
‘Ethics: Nursing’s Foundation’
Eileen Weber, DNP, JD,
PHN, BSN, RN
‘Law Review’
Eileen Weber, DNP, JD,
PHN, BSN, RN
Break
‘Building on Nursing’s
Ethics Leadership:
Your Next Move’
Eileen Weber, DNP, JD,
PHN, BSN, RN
Lunch (Provided)
‘Resilience: Maintaining
Strength and Spirit in
Challenging Times’
Virginia Beeson, BSN,
MSN, NEA-BC
Break
‘Resilience: Maintaining
Strength and Spirit in
Challenging Times’
Virginia Beeson, BSN,
MSN, NEA-BC
Evaluations
The purpose of this educational offering is to
enhance legal and ethical nursing practice and build
leadership skills in our healthcare environment.
Contact hours for this continuing nursing
education activity will be submitted to the North
Dakota Board of Nursing. Please contact Mary
Smith for more information regarding contact hours.
Conference Objectives Upon completion of this program, the participants will be able to:
1. Indicate how to prepare students and colleagues to take competent, principled actions to resolve
ethical dilemmas by explaining the legal framework that relates to ethical issues in healthcare.
2. List at least three resources for ethical practice and education available from the American
Nurses Association Center for Ethics and Human Rights.
3. Describe Healthcare Legal Partnerships and their growing impact on healthcare’s Triple Aim.
4. Complete a personal action plan for enhancing ethical practice that demonstrates an understanding
of the participant author’s authority, accountability, and duty for ethical practice environments.
5. Describe at least two emerging ethical dilemmas in healthcare.
6. Define what is meant by “resilience.”
7. Describe why resilience is a critical leadership skill in today’s world.
8. List at least three strategies to become a more “resilient” leader.
Hiring RNs & LPNs
$5,000 SIGN ON
BONUS POSSIBLE
We hire new graduates and
offer tuition reimbursement
For more information,
call 701-845-8222 or visit our website at
www.sheyennecarecenter.com.
Applications can also be picked up at
979 Central Ave N, Valley City ND 58072
and faxed back to 701-845-8249.
Visit our new Facebook page @ www.facebook.com/sheyennecarecenter

February, March, April 2017 The North Dakota Nurse Page 7
POLST Update for North Dakota
Nancy Joyner
Kristina Schlecht
Nancy Joyner, RN, MS
President, Honoring Choices® North Dakota
Nationally Certified POLST Trainer
North Dakota POLST contact
and
Kristina Schlecht, MD
Associate Director, UND Center for Family
Medicine- Minot, NDMA Ethics Chair
Medical Director/POLST Champion
In 2010, the North Dakota Medical Association
urged North Dakota physicians and healthcare
providers across all healthcare settings to consider
Physician Orders for Life-Sustaining Treatment
(POLST) elements. (NDMA Checkup, December 2010).
A workgroup developed creating a North Dakota
Advance Care Planning Initiative now known as
Honoring Choices® North Dakota (HCND). The vision
of HCND is: “to create a culture across ND where
continuous (on-going) advance care planning (ACP) is
the standard of care and every individual’s informed
preferences for care are documented and upheld.”
Defining Advance Care Planning
and the role of POLST
Advance care planning (ACP) is “a personcentered,
ongoing process of communication that
facilitates individuals’ understanding, reflection and
discussion of their goals, values and preferences for
future healthcare decisions (Respecting Choices®,
Gunderson Health System). HCND recognizes ACP
as a process. It starts with a conversation, which
then is documented with a healthcare directive then
translated into medical orders.
Why POLST?
A tool to improve the quality of patient care and
reduce medical
• Identifies patients’ values and wishes
regarding medical treatment
• Communicates and respects patient’s wishes
by creating portable medical orders.
Key Components:
• Thoughtful, facilitated advance care planning
conversations
• Between health care professionals and
patients and those close to them
• Determines what treatments patients do and
do not want
• Based on their personal beliefs and current
state of health.
How does POLST work?
• A set of medical orders
• Completed as a result of the process of shared
decision-making- facilitated conversations
POLST continued on page 8
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difference in the lives of people.
MSLCC offers excellent benefits, shift and weekend differentials and
numerous incentives, including sign-on bonuses and tuition reimbursement
program. To view our current openings and details of what we have to offer,
please visit our website and apply at www.mslcc.com or contact us at
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Full-time
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LPNs - $ 3,500 Sign on bonus
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Job Seekers/State Government Job Openings.
Questions? Call Cindy at 701-253-3210
Northwood Deaconess Health Center
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Page 8 The North Dakota Nurse February, March, April 2017
POLST continued from page 7
• Values, beliefs, including spiritual and
religious and goals for care (can be both
realistic and more hopeful)
• The health care professional presents the
patient’s diagnosis, prognosis, and treatment
alternatives
• The benefits and burdens of life-sustaining
treatment.
• Reach an informed decision about desired
treatment
• Follows patient across treatment settings
• Effective communication
• Involves patient (or legally designated
decision-maker) and health care professionals
(physicians, nurses, social workers, chaplains)
• Ensures decisions are sound
• Based on the patient’s understanding
• Their medical condition
• Their prognosis
• The benefits and burdens of treatment
• Their personal goals for care
Healthcare Directive
POLST
All adults >18 y.o.
Any age, serious illness, at end of life
Population
or frailty
Time Frame Future care/future conditions Current care/current conditions
Where Completed Any setting, not necessarily medical Medical setting
Resulting Product
Comparing POLST Form to Healthcare Directive
Healthcare agent appointed and/or
statement of preferences
Medical orders based on shared
decision making
Healthcare Agent Role Cannot complete Can consent if patient lacks capacity
EMS Role Does not guide EMS Guides EMS as a medical order
Portability Patient/Family Responsibility Healthcare Professional Responsibility
Periodic Review Patient/Family Responsibility Healthcare Professional Responsibility
The POLST paradigm was developed to improve
the quality of patient care for those facing serious,
advanced, progressive and chronic illnesses
(including patients with frailty or the surprise
question*). It also hopes to reduce medical errors
by creating a system that identifies, communicates
and respects patients’ wishes regarding medical
treatment by creating portable medical orders.
Clinical experience and research show healthcare
directives are not sufficient alone to assure that
their preferences for treatment will be honored
unless a POLST form is also completed (POLST.
org website).
Who should have a POLST?
• Serious, advanced, progressive and chronic
illnesses (including patients with frailty or
the surprise question
* Surprise question: “Would you be surprised
if this patient died within the next year?”
Status of POLST in North Dakota
Over the past four years, a workgroup, under
the direction of HCND revised the original
2007 POLST form to create a statewide form
meeting the requirements of the National POLST
Paradigm Task Force (NPPTF). Although there
are still isolated areas of the 2007 POLST from
Altru Health System, the new 2016 form is
complete and awaiting education and placement on
the Honoring Choices® North Dakota website. It
is the intent to have the POLST form available on
the website by January 1, 2017.
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February, March, April 2017 The North Dakota Nurse Page 9
Parkinson’s Disease: What Nurses Need to Know
Kathy Roth, MSN, RN
Parkinson’s disease is a degenerative
neurological disorder with no known cause.
Approximately one million people in the U.S. live
with Parkinson’s disease and another 60,000
are diagnosed each year (Parkinson’s Disease
Foundation [PDF], 2015). Parkinson’s disease is
characterized by the death of neurons that produce
dopamine in the brain (National Institute of
Neurological Disorders and Stroke [NINDS], 2016).
This decrease in dopamine affects movements
and coordination. There is no definitive diagnostic
test for Parkinson’s disease, so diagnosis is based
on symptoms. The primary motor symptoms of
Parkinson’s disease include a tremor that usually
occurs at rest, bradykinesia, rigidity, and postural
instability. Additional motor symptoms may
include freezing of gait, shrinking of handwriting,
drooling and excess saliva, a mask-like expression,
and flexed posture. Nonmotor symptoms
include loss of sense of smell, constipation, REM
sleep disorder, mood disorder, and orthostatic
hypotension. People may also develop depression,
memory difficulties, and in some cases dementia.
The symptoms will worsen throughout the course
of the disease (NINDS, 2016). The Parkinson’s
Disease Foundation suggests that a person with
symptoms consider making an appointment with a
movement disorder specialist.
The treatment and care for people with
Parkinson’s disease has advanced in the last few
years. People with Parkinson’s disease often find
that their medications are very effective early
in the disease. The most common medication
prescribed for Parkinson’s disease is carbidopa/
levodopa, although there are six categories of
medications that can be used. These include
levodopa, dopamine agonists, COMT inhibitors,
MAO B inhibitors, anticholinergics, and other
medications including amantadine (PDF, 2015).
Carbidopa/levodopa can be given in different
formulations and is prescribed in multiple
doses throughout the day. As symptoms change,
schedules must be adjusted to achieve optimal
relief of symptoms for each patient.
Over time, the duration that levodopa works
begins to shorten. People will often cycle
throughout the day, experiencing “on” periods,
where their medications are working well, and
“off” periods where their medications have stopped
working and their symptoms return (PDF, 2015).
There are treatment options for “off” periods
including additional or different doses of the
carbidopa/levodopa and medications that can
extend the effect of the carbidopa/levodopa. One
new treatment for people with Parkinson’s disease
is the Duopa pump. This pump infuses carbidopa/
levodopa gel directly into the small intestine
(Duopa, 2016). The pump runs for 16 hours a day
and is off for 8 hours at night. The continuous
infusion can decrease the fluctuations and can
therefore increase functioning during the day
(Duopa, 2016). People may continue to take oral
medications during the night.
People may experience a potential side effect
from the carbidopa/levodopa called dyskinesias.
Dyskinesias are involuntary twisting or writhing
movements, that may or may not bother people. If
bothersome, they may be helped with medication
adjustments or deep brain stimulation (DBS)
surgery, where electrodes are inserted into the
deep brain region (NINDS, 2016). DBS can also
help motor symptoms of tremor, bradykinesia,
and rigidity.
How can nurses help people with Parkinson’s
disease? We need to have an active role in educating
and assisting people with Parkinson’s disease.
• The first thing that nurses can do,
and possibly the most important, is
understanding the exact timing of how
the person takes their medications. People
with Parkinson’s disease are most often
on a medication schedule that keeps
their symptoms at a minimum. Even the
slightest disruption in their medications
can exacerbate their symptoms. People with
Parkinson’s disease need their pills on time.
Ask each patient/family the exact time of
medication dosing, and enter times into the
EMR so the at-home dose can be continued in
the alternative care setting.
• Understanding that a team approach is
important for Parkinson’s disease. Physical
therapists, occupational therapists, speech
therapists, nutritionists, and social workers
may be beneficial for people with Parkinson’s
disease.
• Because of the potential autonomic nervous
system changes, nurses should monitor
orthostatic blood pressures in people with
Parkinson’s disease. Constipation is also
very common. Nurses should educate on the
importance of maintaining regular bowel
habits. Polyethylene glycol is approved by
the American Academy of Neurology for the
treatment of Parkinson’s constipation (AAN,
2016).
• Regular exercise can help decrease symptoms
and improve mobility, strength, flexibility,
and balance. Walking, swimming, dancing,
and Tai Chi are all good exercise options
(PDF, 2015).
• Poor appetite and difficulty swallowing can
lead to problems with nutrition. Encourage
people to eat meals 30 minutes before or
1 hour after taking Parkinson’s disease
medications, as dietary protein can interfere
with Parkinson’s disease medication
absorption. Their diet should include plenty
of fiber and fluids, with a high calorie intake.
A soft diet possibly with thickened liquids can
help ensure proper nutrition when swallowing
is difficult.
• Encourage people with Parkinson’s disease and
their support person to find a support group.
Organizations and groups can support people
living with Parkinson’s disease and their family
members or caregivers (PDF, 2015).
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• As Parkinson’s disease advances, the
combination of motor and non-motor symptoms
can complicate the treatment regimen. Nonmotor
symptoms are not recognized as
frequently as motor symptoms. Assessing and
educating for non-motor symptoms can increase
the quality of life.
Research into new treatments for Parkinson’s
disease, including medications and surgeries, is
continually being conducted. What was once a
hopeless trajectory, has become a disease with very
treatable symptoms, and hopefully a cure is just
around the corner.
Nurses are critical for Parkinson’s care and
need education to understand the complex needs
of people with Parkinson’s disease. Nursing
faculty can apply for the Edmond J. Safra
Visiting Nurse Faculty Program at http://www.
pdf.org/edmondjsafranursing to learn more about
Parkinson’s disease for education of our future
nurses.
References:
American Academy of Neurology (2016). Treatment of
nonmotor symptoms of Parkinson disease. Retrieved
from https://www.aan.com/Guidelines/home/
GetGuidelineContent/409
Duopa (2016). About Duopa. Retrieved from https://
www.duopa.com/about-duopa
National Institute of Neurological Disorders and Stroke
(2016). NINDS Parkinson’s disease information
page. Retrieved from http://www.ninds.nih.gov/
disorders/parkinsons_disease/parkinsons_disease.
htm
Parkinson’s Disease Foundation (2015). Parkinson’s
Disease Q & A (7th ed.). Retrieved from
www.pdf.org
Application process is ongoing. Application submission is due
October 1st for Spring semester and May 1st for Fall semester.
For info: 858.3101 or 1.800.777.0750
www.minotstateu.edu/nursing
or email nursing@minotstateu.edu.
Be seen. Be heard.

Page 10 The North Dakota Nurse February, March, April 2017
MRSA
Appraised by: Morgan Schmitz, RN;
Kristi Toennis, RN; & Melissa Wagner, RN
(Mayville State University RN-to-BSN students)
Clinical question:
In patients with a positive Methicillin-resistant
Staphylococcus aureus (MRSA) nasal culture, does
the use of contact precaution measures reduce MRSA
transmission compared to universal precautions
alone?
Articles
Harbarth, S., Fankhauser, C., Schrenzel, J., Christenson,
J., Gervaz, P., Bandiera-Clerc, C., Renzi, G., Vernaz,
N., Sax, H., & Pittet, D. (2008). Universal screening
for methicillin-resistant staphylococcus aureus at
hospital admission and nosocomial infection in
surgical patients. JAMA, 299(10), 1149–1157.
Huskins W., Huckabee C., O’Grady N., Murray P.,
Kopetskie H., Zimmer L., Walker M., Sinkowitz-
Cochran R., Jernigan J., Samore M., Wallace
D., Goldmann D. (2011). Intervention to reduce
transmission of resistant bacteria in intensive care.
The New England Journal of Medicine, 364(15), 1407-
1418. doi:10.1056/NEJMoa1000373
Morris, A. (2011). Active surveillance and use of barrier
precautions did not reduce colonization and infections
with MRSA and VRE in adult ICUs. Annals of
Internal Medicine, 115(2), 2-13. doi: 10.7326/0003-
4819-155-4-201108160-02013
Worby, C. J., Jeyaratnam, D., Robotham, J. V., Kypraios,
T., O’neill, P. D., De Angelis, D., & Cooper, B. S.
(2013). Estimating the effectiveness of isolation and
decolonization measures in reducing transmission
of methicillin-resistant staphylococcus aureus
in hospital general wards. American Journal of
Epidemiology, 177(11), 1306-1313.
Stay up-to-date and find your dream job!
Job Board: Search job listings in
all 50 states.
Publications: New publications
and articles added weekly!
Events: Find events for nursing
professionals in your area.
www.nursingALD.com
Additional reference:
Center for Disease Control. Precautions to prevent the
spread of MRSA in healthcare settings. Retrieved
on April 24, 2016 from: http://www.cdc.gov/mrsa/
healthcare/clinicians/precautions.html
Synthesis of evidence
Our team reviewed 18 articles and chose the
following four studies to further evaluate the
effectiveness of contact precautions in comparison
to standard precautions. Multiple studies were
completed in comparing control and intervention
groups. Interventions included decolonization
with the use of mupirocin and chlorhexidine
bathing of identified MRSA positive patients,
enhanced authority of standard precautions,
and surveillance screening upon admission and
throughout the trials to evaluate effectiveness of
interventions.
The first study completed by Harbarth,
Fankhauser, Schrenzel, Christenson, Gervaz,
BandieraClerc, Renzi, Vernaz, Sax, & Pittet in
2008, conducted the largest controlled evaluation
of the effect of MRSA screening on admission
in patients undergoing surgery. This study
is quite important because even with high
adherence to screening and strict adherence to
contact precautions, they failed to reduce MRSA
transmission. In contrast, patients undergoing
elective procedures who were found to be MRSA
positive during their outpatient visit received
prophylaxis with decolonization with mupirocin
ointment and chlorhexidine bathing and developed
no MRSA infection or complications during their
hospital stay.
The second study done by Huskins, Huckabee,
O’Grady, Murray, Kopetskie, Zimmer, Walker,
Sinkowitz-Cochran, Jernigan, Samore, Wallace,
and Goldmann in 2011 reviews a study of
multiple ICU units within three, six-month time
period studies. It compared contact precautions,
preventive gloving, and standard precautions
for three separate groups, within a control group
and an intervention group. It compared the
interventions as applied per particular group
along with cares, interventions and hand washing.
The study found that there was overall no
significant reduction in the spread of MRSA with
extended isolation precautions.
The next study by Morris, (2011), was conducted
in 19 adult medical, surgical, or medical-surgical
ICUS. It involved 1200 patient-days in a 6 month
period. The patients in this study received
surveillance nasal swabs for MRSA. They used
standard precautions for patients except those
who were infected or colonized MRSA. This study
concluded in adult intensive care units, culturebased
active surveillance and expanded use of
barrier precautions did not reduce the incidence of
colonization and infection with MRSA.
The last study completed by Worby, Jeyaratnam,
Robotham, Kypraios, O’neill, De Angelis, & Cooper
in 2013, conducted a prospective RCT crossover
study demonstrating the effectiveness of isolation
and decolonization measures in reducing MRSA
transmission in hospital wards. It showed the
combined results of both isolation and decolonization
were effective in reducing MRSA transmission
by 64%. So, with the other studies showing
the ineffectiveness of isolation in preventing
transmission this suggests decolonization efforts are
very important in reducing MRSA.
Bottom line
In conclusion, according to the research found,
contact precautions do not reduce the transmission
of MRSA compared to standard precautions
alone. Contact precautions single-handedly do not
effectively reduce the spread of MRSA in colonized
patients. Research points to multiple activities that
reduce the spread of MRSA in colonized patients:
active surveillance such as nasal swab testing
combined with enhanced standard precautions
defined as hand washing, gloving and gowning
when necessary with the use of dedicated medical
equipment, decolonization efforts with the use of
Mupirocin and daily Chlorhexidine bathing, and
increased environmental cleaning are most effective
in the reduction of the transmission of MRSA.
Implications for nursing practice
Nurses are the first line of defense when
it comes to spreading germs and by a change
in practice, nurses can not only reduce the
risk of MRSA transmission but also decrease
healthcare costs while improving patient and staff
satisfaction. Key measures for nurses to implement
from the Center for Disease Control (2016) to help
prevent the spread of MRSA:
• Perform hand hygiene judiciously.
• Clean equipment after every patient care use.
• Use dedicated medical equipment when
appropriate.
• Decolonization & bathing with Chlorhexidine
soap or wipes.
• Maintain a clean patient care environment,
as germs can live on inanimate objects and
spread.
• Encourage patients and family to complete
hand hygiene.
• Provide education on the spread of germs and
MRSA.
• Know, review and reassess your facilities
policy on infection control, intervention and
prevention.

February, March, April 2017 The North Dakota Nurse Page 11
Umbilical Cord Clamping
Appraised by: Christina Berdahl, RN;
Emily Christensen, RN; Witeh Esoe, RN
(Mayville State University RN-BSN students)
Clinical question:
How does delayed cord clamping in newborns
affect the incidence of post-delivery complications
compared to newborns whose umbilical cord is
clamped immediately after delivery?
Articles:
Chaparro, C. M. (2011). Timing of umbilical cord
clamping: Effect on iron endowment of the newborn
and later iron status. Nutrition Reviews, 69S30-S36.
doi:10.1111/j.1753-4887.2011.00430.x
Christensen, R. D., Baer, V. L., Gerday, E., Sheffield,
M. J., Richards, D. S., Shepherd, J. G., & ... Oh, W.
(2014). Whole-blood viscosity in the neonate: Effects
of gestational age, hematocrit, mean corpuscular
volume and umbilical cord milking. Journal of
Perinatology, 34(1), 16-21. doi:10.1038/jp.2013.112
Erickson-Owens, D. A., Mercer, J. S., & Oh, W. (2012).
Umbilical cord milking in term infants delivered
by cesarean section: A randomized controlled trial.
Journal of Perinatology, 32(8), 580-584. doi:10.1038/
jp.2011.159
Hutchon, D. R. (2012). Immediate or early cord clamping
vs delayed clamping. Journal Of Obstetrics &
Gynaecology, 32(8), 724-729. doi:10.3109/01443615.2
012.721030
Synthesis of evidence:
Delayed umbilical cord clamping has been
practiced around the world for many generations.
However, the exact timing of clamping the umbilical
cord in preterm and term infants has been a topic
of concern. Thus, controversies have been raised
among healthcare workers (obstetricians, midwives,
and pediatricians). As a result, the following PICO
question was formulated to further research this
topic: How does delayed cord clamping in newborns
affect the incidence of post-delivery complications
compared to newborns whose umbilical cord
is clamped immediately after delivery? The
information was gathered from eighteen research
articles which were critically reviewed and
summarized to conclude findings to support the
PICO research topic. Four articles narrowed down
the following important pieces of information:
• Blood viscosity of newborns with delayed cord
clamping did NOT lead to hyper viscosity
in the neonate’s blood which was noted as
a potential life-threatening risk with this
intervention (Christensen et al., 2014).
• Delayed cord clamping (DCC) supports
placental transfusion by allowing a 20-30%
whole blood volume increase and a 50-60% red
blood cell volume increase (Erickson-Owens,
Mercer, & Oh, 2012).
• The timing of umbilical cord clamping has a
direct impact on the amount of iron present
in the neonate’s system the first few days
through the first four months. The increased
amount of blood present in the infant who
had DCC reveals a notably higher level of iron
(Chaparro, 2011).
• Delayed cord clamping reduces the risk for the
need for transfusions, increases hemoglobin
& hematocrit levels, decreases risk for
intraventricular hemorrhage, decreases the
risk for iron deficiency, increases circulatory
volume, increases stem cells, and provides
overall essential life support to the neonate
(Hutchon, 2012).
Bottom line:
Delayed cord clamping reduces the risk for
the need for transfusions, increases hemoglobin
& hematocrit levels, decreases risk for
intraventricular hemorrhage, decreases the risk
for iron deficiency, increases circulatory volume,
increases stem cells, and provides overall essential
life support to the neonate. Improving outcomes
and reducing post-delivery complications still
needs further research on all neonatal age groups
with larger sample sizes to determine exactly what
gestational ages and at what time the umbilical
cord should be clamped.
Implications for nursing practice:
Nurses should engage in researching this topic
to become more knowledgeable on the potential
risks and benefits of this practice. They should
be aware of how long providers in their labor and
delivery department are waiting before they clamp
the umbilical cord and compare this to research.
The topic should be discussed among nursing staff
and with delivery teams to raise awareness and
to promote delayed cord clamping. Also, nurses
should educate the mothers about the differences
in the timing with the potential risks and benefits
associated with each. Most importantly, nurses
should take part in ongoing studies in their areas
to promote research, participate in studies that
include all neonatal age groups with larger sample
sizes irrespective of the method of delivery to
determine exactly at what age and time umbilical
cord clamping should be performed.
North Dakota’s 62,100 Family
Caregivers Need Our Support
Family caregiving affects just about everyone. If
you haven’t been a caregiver, chances are you will
be in the future.
In North Dakota, more than 62,000 family
caregivers help parents, spouses, children
with disabilities, and other loved ones live
independently at home. They provide a wide range
of services for their loved ones, including bathing,
dressing, transportation, grocery shopping,
meal preparation, housework, and managing
finances. They often serve as care coordinators,
communicating with health professionals and
accompanying their loved ones to medical
appointments.
Two pieces of legislation that would provide
support to North Dakota’s unpaid family
caregivers have been introduced in the 2017
session of the North Dakota Legislature.
After months of study, the Legislature’s Interim
Human Services Committee in September
unanimously endorsed the caregiver bills.
The Caregiver Advise Record and Enable
(CARE) Act would ensure that family caregivers
are kept informed and are provided with an
explanation and a demonstration of the medical
tasks they will perform at home after a loved
one is discharged from a hospital. Roughly
50 percent of our state’s family caregivers
performing medical or nursing tasks do not
get the appropriate instruction or training to
perform these tasks.
A second bill to provide support for
family caregivers was developed based on
recommendations from a study conducted in 2016
by the North Dakota State University Extension
Service.
Specifically, the bill is a first step in
implementing the recommendations made in the
NDSU Extension study. This bill would:
• Allow the Department of Human Services to
apply for a federal grant to provide caregivers
with additional respite care.
• Direct the Aging Services Division to
improve outreach and resources to help
family caregivers find and navigate available
programs and services.
• Appropriate approximately $180,000
to expand NDSU Extension’s caregiver
training program.
• Update the fee schedule for the Service
Payments for the Elderly and Disabled
program, making home care services more
affordable, especially for those on fixed
incomes.
• Include legislative intent language
reflecting the state’s need to better
balance its long-term care funding to help
individuals with the support they need to
safely remain in their own homes rather
than having to move to more expensive
institutional care.
Increased access to respite care across the
state is critical. Respite care helps to support
family caregivers, many who are on call 24
hours a day, seven days a week, by giving them
a hard-earned, well-deserved break. National,
state, and local surveys have shown respite care
to be the most frequently requested service from
family caregivers.
AARP has established itself as the leader
on family caregiving advocacy in the state to
advance policy initiatives that would support
the tens of thousands of North Dakotans
performing this labor of love.
Sign up for ongoing updates on this
legislation during the 2017 session at www.aarp.
org/getinvolved.
You can learn more about caregiver
resources in North Dakota by calling the
Family Caregiver Support Program at 1-855-
462-5465. AARP’s caregiving resources can be
found at www.aarp.org/caregiving, or request a
copy of “Prepare to Care: A Resource Guide for
Families” by calling the AARP North Dakota
office at 1-866-554-5383.
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Page 12 The North Dakota Nurse February, March, April 2017
American Nurses Association
Nurses Lead in Fighting Opioid Crisis
From the American Nurse Today Journal
November 2016, Vol. 11 No. 11
Authors: Janet Haebler, MSN, RN, and Tim Casey
Nowhere in the nation are we immune to the
ravages of the opioid epidemic. The crisis has
struck our cities, suburbs, and rural communities.
Across party lines, lawmakers at the state
and federal levels are searching for solutions.
Registered nurses (RNs) are uniquely positioned to
help tackle this public health crisis, and ANA has
been busy educating legislators about how.
As the most trusted direct-care providers on
the frontlines of the epidemic, RNs help patients
understand pain treatment options and play a
key role in the prevention of opioid overuse and
dependence. ANA has sought to advance nursing’s
role in fighting the opioid crisis by addressing
barriers and expanding access to treatment, as
described below.
Expand access to medication-assisted treatment
Medication-assisted treatment (MAT), combined
with counseling, serves as one of the most effective
forms of treatment for opioid use disorders. For
millions of opioid addicts who are uninsured,
homeless, or recently incarcerated, however, getting
on – and staying on – medication is a struggle. To
improve access to treatment, ANA has advocated
for MAT prescribing authority for nurses, as well as
expanded private insurance coverage and Medicaid
health benefits.
Expand access to overdose reversal drug
Unfortunately, addiction to opioids, including
heroin, is difficult to treat. Not everyone recovers.
Among those who do, most relapse at least once
before sustained recovery. With that in mind,
ANA has advocated strongly for the expansion
of naloxone access. Naloxone is a life-saving
medication that rapidly blocks the effects of opioids
when signs and symptoms of a prescription opioid
or heroin overdose first appear. Some states have
looked for ways to expand access to naloxone while
protecting health professionals from criminal,
civil, and professional liability (Good Samaritan
Overdose Immunity Law).
Increase use of physician drug monitoring
programs
Physician drug monitoring programs (PDMPs)
are integral to reducing inappropriate prescribing
and abuse of prescription medications. PDMPs are
state-run electronic databases that can provide
a prescriber or pharmacist with information
regarding a patient’s prescription history, thereby
allowing them to identify patients who potentially
are knowingly or unknowingly misusing
medications. ANA supports efforts to increase
utilization of PDMPs. The Department of Health
and Human Services is working toward the goal
of doubling the number of healthcare providers
registered with their PDMP in the next 2 years.
Culture change
ANA recognizes that we must also look beyond
legislative and regulatory solutions to address
the opioid epidemic. As educators and patient
advocates, nurses embrace a holistic approach
to addressing pain, including nonopioid therapy
alternatives, such as rehabilitative therapy,
regional anesthetic interventions, surgery,
psychological therapies, and complementary and
alternative medicine.
ANA believes nurses can lead culture change
around pain management and opioid prescribing.
To that end, we are working closely with the
White House to promote and educate nurses
on the new Centers for Disease Control and
Prevention guidelines for opioid prescribing,
which aim to improve clinical decision
making and reduce inappropriate prescribing.
Additionally, ANA continues to support
innovative industry partners who are stepping
up to promote valuable medication take-back
programs, as well as those conducting research to
improve abuse-deterrent formulas for prescription
medications.
In recent years, ANA and its state affiliates
have advocated successfully for many of these
changes—and more. At the federal level, ANA
argued strongly for MAT prescribing authority,
increased access to the overdose-reversal drug
naloxone, and expanded treatment options for
those living in areas most affected by the opioid
crisis. Passage of the Comprehensive Addiction
and Recovery Act (CARA) in Congress this
summer marked an important victory in the battle
against substance abuse disorders.
While CARA and the laws enacted in the
states represent enormous progress in addressing
this epidemic, we must now work to ensure the
necessary funding is appropriated. Only then
will we truly begin to expand access to critical
treatment services and turn the tide on this
devastating public health crisis.
For ANA resources on the opioid epidemic, visit
• nursingworld.org/MainMenuCategories/Workplace
Safety/Healthy-Work-Environment/Opioid-Epidemic
• (http://nursingworld.org/MainMenuCategories/Work
placeSafety/Healthy-Work-Environment/Opioid-Epidemic).
Janet Haebler and Tim Casey are senior associate
directors in Government Affairs at ANA.
CAREER OPPORTUNITY FOR NURSES - $4,000 bonus
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shifts. For a limited time, MMHC is offering a $4,000 sign-on bonus for 24 month commitment
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Caring professionals interested in providing Resident centered quality
care should contact Loretta Gerving, DON, at 701-348-3107 for
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February, March, April 2017 The North Dakota Nurse Page 13
ANA President Responds
to Department of
Veterans Affairs Final
Rule on APRNs
SILVER SPRING, MD – The Department
of Veterans Affairs (VA) released a final rule
granting full practice authority to three of the four
established Advanced Practice Registered Nurses
(APRNs) roles when they are acting within the
scope of their VA employment. Nurse Practitioners
(NPs), Clinical Nurse Specialists (CNSs) and
Certified Nurse-Midwives (CNMs) will now have
full practice authority within the VA Health System
as a mechanism for extending veterans access to
a full range of qualified health professionals. ANA
is disappointed that the VA failed to extend full
practice authority to Certified Registered Nurse
Anesthetists(CRNAs).
The following statement is attributable to
American Nurses Association (ANA) President
Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, in
response to the final rule:
“The American Nurses Association is pleased with
the VA’s final rule allowingAPRNs to practice to the
full extent of their education and training. This rule
puts veterans’ health first, and will help improve
access to the timely, effective and efficient care
they have earned. However, ANA is concerned with
the final rule’s exclusion of CRNAs, which is solely
based on the VA’s belief that there is no evidence of
a shortage of anesthesiologists impacting access to
care. We join with our colleagues in continuing to
advocate for CRNAs to have full practice authority
within the VA health care system.
“The 6,000 APRNs serving in the VA health care
system are dedicated to delivering the best possible
care to our heroes and their families. Today’s rule
is the right policy at the right time, and we applaud
the VA for taking this vital step in ensuring access to
care and keeping America’s veterans healthy.”
APRNs are nurses who have met advanced
educational and clinical practice requirements, and
whose services range from primary and preventive
care to mental health, birthing and anesthesia.
The proposed rule generated an unprecedented
number of comments from veterans, health care
providers and the general public. The final rule
amends the VA’s medical regulations to permit full
practice authority (FPA) for three of the four APRN
roles when they are acting within the scope of their
VA employment and authorizes the use of APRNs to
provide primary health care and other related health
care services to the full extent of their education,
training, and certification, without the clinical
supervision or mandatory collaboration of physicians.
American Nurses Association
The North Dakota Department of Health has employment
opportunities for REGISTERED NURSES, DIETITIANS
AND QUALIFIED INTELLECTUAL DISABILITIES
PROFESSIONALS (QIDP) as a Health Facilities Surveyor.
How would you like every weekend to be a three-day
weekend plus have ten paid holidays each year?
Join our team of dedicated nurses and dieticians and you
will travel across our great state to assure compliance with
state and federal standards.
Overnight travel required and you will be reimbursed for
your food & lodging expenses.
Here’s a chance to make a difference in a unique way using
your education and experience.
As a state employee, you will enjoy our excellent benefits
package and a four-day work week.
Immediate Openings Available
The position will remain open until filled.
A Recruitment Bonus May be Available
Competitive Salary
Please contact:
Bruce Pritschet, Division of Health Facilities
600 E. Boulevard Ave Dept 301
Bismarck, ND 58505-0200 | 701.328.2352
Website: https://www.cnd.nd.gov/psc/recruit/EMPLOYEE/
HRMS/c/HRS_HRAM.HRS_APP_SCHJOB.GBL?
An Equal Opportunity Employer
The Diabetes Summit
March 30 and 31, 2017
Radisson Hotel | 605 East Broadway Avenue Bismarck, ND
Sponsored by:
North Dakota Department of Health Diabetes Program
Dakota Diabetes Coalition
For Nurses, Lifestyle Coaches, Diabetes Educators,
Dietitians, Social Workers
To register click here:
https://diabetessummit2017.eventbrite.com
Continuing Education Credits Applied For from ND Board
of Nursing, Commission on Dietetic Registration and the
ND Board of Social Work Examiners on topics related to:
• Facilitating Lasting Behavior Change
• Using Culinary Skills to Promote Health
• Diabetes and Pregnancy
• Diabetes and Kids
• Quality Management in Diabetes Education
• Geriatric Diabetes Care
• Complications of Diabetes
Cost: $85.00
www.diabetesnd.org
Stipends Available – Watch
For Registration Details
Funding for this conference was made
possible (in part) by the Centers for
Disease Control and Prevention. The views
expressed in written conference materials
or publications and by speakers and
moderators do not necessarily reflect the
official policies of the Department of Health
and Human Services, nor does the mention
of trade names, commercial practices, or
organizations imply endorsements by the
U.S. Government.

Page 14 The North Dakota Nurse February, March, April 2017
American Nurses Association
ANA Ready to Work with
New Administration to
Improve Health for All
SILVER SPRING, MD – The American Nurses
Association (ANA) is steadfast in its commitment
to improve the health of people across the country.
We look forward to sharing the valuable expertise
of nurses with the new Administration and
Congress.
“As President-elect Trump looks to improve
America’s health care system we are ready to work
with his administration to advance health care
that is accessible, affordable, equitable, integrated
and innovative,” said Pamela F. Cipriano, PhD,
RN, NEA-BC, FAAN, president of ANA.
“This new Administration also has an
opportunity to unite the country around a shared
vision that puts protecting and promoting quality
health care for all Americans above partisan
politics,” said Cipriano. “ANA stands ready to offer
support and assistance to make this opportunity a
reality.”
In addition to the presidential race, many
advocates of health care and nursing priorities
were elected to the U.S. Congress on Tuesday. In
total, 83 percent of the 52 candidates endorsed by
ANA’s Political Action Committee (PAC) won their
election and will serve in the 115th Congress.
Nurses are the largest single group of health
care professionals, and the nursing profession has
been voted as the most trusted profession for 14
years straight. ANA will continue to leverage this
trust to advocate for access to quality, affordable
health care, optimal nurse staffing and other
policies that remove barriers to health care for the
broader community.
For more information, visit NursingWorld.org.
Visit us online
anytime...
anywhere.
www.ndna.org
Join Our Team
Glacier National Park, mountains,
lakes, ski resorts, golf, fresh air,
friendly people, and excellent
schools all accompany this rapidly
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Up to $20,000 in sign
on incentives, DOE:
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Labor/Delivery RNs
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Operating Room RNs
Long Term Care RNs
Medical Surgical RNs
ICU RNs
Emergency Room RNs
Contact Laurie O’Leary, Human Resources
310 Sunnyview Lane, Kalispell, MT 59901 • 406-752-1760
loleary@krmc.org • www.kalispellregional.org
Drug Free • EOE
December 5, 2016
Donald J. Trump
President-Elect
1717 Pennsylvania Avenue
Washington, DC 20006
Dear President-Elect Trump:
America’s 3.6 million registered nurses (RNs) care profoundly about the health and welfare
of our nation. Nurses provide expert, compassionate care for people throughout their life and
work in every health care setting. As the largest group of health care professionals and the
nation’s most trusted profession, nurses are a valuable resource for improving the nation’s
health care delivery system.
For decades, the American Nurses Association (ANA) has advocated for health care
system reforms that would guarantee access to high-quality, affordable health care for all.
ANA is calling on you and your administration to prioritize the health of the nation, which
is foundational to progress and economic growth. We are pleased to share our principles for
health system transformation.
ANA’s Principles for Health System Transformation
The system must:
Ensure universal access to a standard package of essential health care services
for all citizens and residents. This includes:
An essential benefits package that provides access to comprehensive services, including
mental health services.
Prohibition of the denial of coverage because of a pre-existing condition.
Inclusion of children on parent’s health insurance coverage until age 26.
Expansion of Medicaid as a safety net for the most vulnerable, including the chronically
ill, elderly and poor.
Optimize primary, community-based and preventive services while supporting
the cost-effective use of innovative, technology-driven, acute, hospital-based
services. This includes:
Primary health care that is focused on developing an engaged partnership with the
patient.
Primary health care that includes preventive, curative, and rehabilitative services
delivered in a coordinated manner by members of the health care team.
Removing barriers and restrictions that prevent RNs and Advanced Practice Registered
Nurses (APRNs) from contributing fully to patient care in all communities.
Care coordination services that reduce costs and improve outcomes with consistent
payment for all qualified health professionals delivering such services, including nurses.
Encourage mechanisms to stimulate economical use of health care services while
supporting those who do not have the means to share in costs. This includes:
A partnership between the government and private sector to bear health care costs.
Payment systems that reward quality and the appropriate, effective use of resources.
Beneficiaries paying for a portion of their care to provide an incentive for the efficient
use of services while ensuring that deductibles and co-payments are not a barrier to
receiving care.
Elimination of lifetime caps or annual limits on coverage.
Federal subsidies based on an income-based sliding scale to assist individuals to
purchase insurance coverage.
Ensure a sufficient supply of a skilled workforce dedicated to providing high
quality health care services. This includes:
An adequate supply of well-educated, well-distributed, and well-utilized registered
nurses.
Increased funding, whether grant or loan repayment based, for programs and services
focused on increasing the primary care workforce.
Funding to elevate support for increasing nursing faculty and workforce diversity.
ANA looks forward to working with you and your administration to address our nation’s
health care challenges. We look forward to sharing the expertise of nurses throughout
your transition period and presidency to improve the health care system and the health of
the nation. Should you or your staff have any questions, please contact me or Michelle Artz,
Director, Government Affairs (Michelle.Artz@ana.org or 301-628-5098).
Yours in partnership,
Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN
President
Cc: Andrew Bremberg

February, March, April 2017 The North Dakota Nurse Page 15
Join NDNA Now!
Use form provided or go to www.NDNA.org
Nurses Rank #1 Most
Trusted Profession for
15th Year in a Row
NDNA10
SILVER SPRING, MD – The American public
has again ranked nurses as the professionals
with the highest honesty and ethical standards,
according to a Gallup poll released December 19.
The annual poll marks the 15th consecutive year
that nurses have been ranked the most trusted
out of a wide spectrum of professions, including
medical doctors and police officers.
“Every day, millions of nurses are on the front
lines in the fight to improve the health of all
Americans,” said Pamela F. Cipriano, PhD, RN,
NEA-BC, FAAN, president of the American Nurses
Association. “Whether nurses are by the bedside
or in the board room, we continue to be a trusted
resource and a vital part of our nation’s health
care system. This poll reflects the trust the public
has in us, and we’ll continue to work hard to keep
that trust.”
According to the poll, 84 percent of Americans
rated nurses’ honesty and ethical standards as
“very high” or “high.” The next closest profession,
pharmacists, was rated 17 percentage points
behind nursing.
“Trust plays an important role in the
relationship between nurses and the patients we
serve,” said Cipriano. “ANA encourages nurses
to draw on that trust to engage with consumers
to improve their health and to advocate for
patients and for the quality of care in this country.
Additionally, I challenge those charged with
making health policy at the facility, local, state
and national levels, to include the trusted voice
of nurses at the decision-making table. No other
profession is held in as high regard by the public,
and given nursing’s frontline perspective on
health care delivery we offer a point of view that is
unmatched.”
In 2017, ANA will continue its longstanding
efforts to advocate for health system reform. The
association is committed to working with the
new administration and Congress to advance
policy that aligns with its four principles for
health system reform: access to care, affordable
and equitable care, quality of care and
workforce.
“NDNA’s Culture of Safety Conference”
March 29th, 2017 | Dakota Medical Foundation, Fargo | Register at ndna.org!
This activity has been approved for 5 contact hours by the Midwest Multistate Division an accredited
approver by the American Nurses Credentialing Center’s Commission on Accreditation

Page 16 The North Dakota Nurse February, March, April 2017
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