TarheelNurse HIGHER GROUND. fall The Official Publication of the. ANA Vice. Legislative Update Many Unanswered Questions Page 5

Transcription

1 fall 2015 TarheelNurse The Official Publication of the north carolina nurses association HIGHER GROUND NCNA MEMBER Ernest grant elected AS ANA Vice president Legislative Update Many Unanswered Questions Page 5 Convention is Almost Here Page 6 Speaking Up About Nursing with a Disability Page 9

2 2 Tar Heel Nurse Fall 2015

3 In This Issue The Tar Heel Nurse is the official publication of the North Carolina Nurses Association. Published six times per year. Subscription price $36 per year, included with membership dues. Index in International Nursing Index and Cumulative Index to Nursing and Allied Health Literature and available in Microform, University Microfilme International. ncna board of directors Officers: Megan Williams, President Mary Graff, President-Elect Angie Bertsch, Secretary/Treasurer fall 2015 vol. 77, No. 5 Board Members: Lauren Crotts, Triad Regional Director Susan Lane, Northwest Regional Director Thompson Forbes, Northeast Regional Director Jeannette Orr, Southeast Regional Director Donna Owen, Southwest Regional Director Maureen Running, South Central Regional Director Erica Saunders, Triangle Regional Director Elaine Scherer, Mountain Regional Director Dennis Taylor, Chair, Commission on Advanced Practice Nursing (CAPN) 3 Announcements 4 President s Message The Pursuit of Nursing Excellence 5 Legislative Update: Many Unanswered Questions 6 Convention is Almost Here! 7 It s Election Season at NCNA! 8 ANA Recap Congratulations Are in Order! 9 Speaking Up About Nursing with a Disability 10 Providing Culturally Sensitive Care to NC s Montagnards 11 Attitude is Everything It s Not About Me!! Leadership Academy Wrapping Up 12 Healthcare Highlights from NCNA s E-Newsletters 13 Conover Expands on APRN Research 14 Hypertension Self- Management Support in Primary Care 15 NC Chiefs of the United States Army Nurse Corps 17 In Your Corner Evolving Healthcare Landscape 18 Member News 18 Calendar of Events NCNA Staff Tina Gordon, Chief Executive Officer Chris Cowperthwaite, Manager of Communications and Outreach Kristen Feneley, Director of Administration and Volunteer Engagement Kristin Goins, Manager of Member Services Ava Langley, Designer/Web Manager Karen Owens, Receptionist/Admin Assistant Christin Peterman, Finance and Programs Specialist Nicole Prybylowski, Director of Nursing Education Diane Tilley, Nursing Practice Consultant Contract: Patrick Ballantine, Government Relations Consultant Latisha Dutch, Event Coordinator Alex Miller, Government Relations Consultant authors / advertising The Tar Heel Nurse welcomes manuscripts from members of the North Carolina Nurses Association. Inquiries and/or manuscripts should be addressed to the Editor. For information and advertising rates, contact NCNA by phone, or the NCNA website. Tar Heel Nurse articles cannot be reproduced without written permission of the Editor. NCNA 2015 ISSN Enterprise Street, Raleigh, NC PO Box 12025, Raleigh, NC Phone: or RNs@ncnurses.org Website: Announcements SAVE THE DATE: INAUGURAL NURSES NIGHT AT THE LEGISLATURE! We are excited to announce a new networking/advocacy event scheduled for the evening of Tuesday, June 21, 2016, at the North Carolina Museum of Natural Sciences in Raleigh. NCNA is partnering with at least 10 other nursing organizations to put this event together; if you are a member of a specialty organization that might be interested in joining this effort, us at RNs@ncnurses.org! HELP THE NCFN WHILE YOU SHOP ONLINE Did you know that Amazon will donate to the North Carolina Foundation for Nursing when you shop through Amazon Smile? You don t pay anything extra with your normal shopping, and the Foundation benefits. Just use our unique url to try it today! Visit WANT TO SHARE YOUR KNOWLEDGE WITH NURSING COLLEAGUES? NCNA is looking for nurse experts to provide quality education opportunities for members, and we d love to add you to the list! If you ve got expertise in a specific topic and would like to make a presentation or lead a webinar, please let us know. For more information, visit On the Cover: ANA Director-At-Large Recent Graduate Jesse Kennedy, ANA President Pamela Cipriano, ANA Treasurer Gingy Harshey-Meade, ANA Vice President Elect Ernest Grant, and ANA CEO Marla Weston. Fall 2015 Tar Heel Nurse 3

4 President s Message The Pursuit of Nursing Excellence Nursing Excellence is the infinite ability to improve the quality and safety of the nursing care you offer. Excellence means being your best. Success, to many, means being better than everyone else. Excellence means being better tomorrow than you were yesterday. Do you work in an environment where excellence is expected? Do you demand excellence of yourself? Do you appreciate excellence when you see it? The pursuit of excellence must be motivated by the ethics of our profession, and be a priority for each and every nurse. Nurses are healthcare s early intervention, warning, and action system, ensuring quality and safety. As a nurse, the patient is the central focus of excellent nursing care. As a nurse, we have the privilege and responsibility to The pursuit of excellence must be motivated by the ethics of our profession, and be a priority for each and every nurse. respect the caring relationship between nurse and patient that is unique to nursing. Research has demonstrated that nurses who deliver excellent nursing care implement nursing in a professional manner, demonstrate a holistic approach to caring, possess certain personal qualities which enhance practice, and relate to patients, families, colleagues, managers, and community members in a competent, cooperative manner. The literature clearly indicates that, unless practitioners are able to articulate that which characterizes excellent nursing care, they will struggle to clearly define the discipline of nursing. During her presentation at the 2013 NCNA Convention, author Suzanne Gordon asked the audience two questions. First, she asked, Does the American public trust nurses? Everyone in the room nodded and verbally answered yes. Then she asked us all a question that has inspired me during my term as NCNA President: Does the American public know what nurses do? Many laughed, but we all answered no. Nurses face challenges that do not arise in many other professions. Nurses render 24-hour care to a variety of highly vulnerable patients. Excellence in nursing demands that nurses not only strive to provide high quality, safe patient care, but that nurses describe in detail what they actually do everyday, every shift, and often hour by hour and minute by minute, under challenging circumstances to improve patient outcomes. Nursing Excellence also embraces the responsibility to monitor one s own health and well being, even as we take into account and often prioritize the need to ensure optimal care for the patient. Nurses are taking the lead to create an infrastructure for excellence that will result in positive outcomes for patients and nurses alike. I encourage each of you to create a vision for your nursing culture and work environment where excellence is expected. Ask yourself What does Nursing Excellence Mean to You? NCNA continues to pursue organizational excellence. Our membership numbers are on the rise! Organizational leaders continue to evaluate the current governance structure to ensure we make meaningful decisions on behalf of the membership. NCNA s dedicated and talented staff continues to seek out professional development opportunities to better support the organizational strategic plan. NCNA s influence is widespread, a direct result of a well-represented membership that has successfully integrated nursing specialties into one united voice while maintaining the uniqueness of each group. NCNA is sought after to influence and impact decisions affecting nursing practice and healthcare for the people of North Carolina. To be a member of NCNA is a sincere honor. NCNA is extremely proud of our members and the excellence they represent. Megan P. Williams, MSN, RN, FNP President, North Carolina Nurses Association mpwilliams@unc.edu Facebook: Megan Parpart Williams LinkedIn: Megan Williams 4 Tar Heel Nurse Fall 2015

5 Legislative Update Many Unanswered Questions By Tina Gordon, MPA, CAE, FACHE; NCNA Chief Executive Officer and Alex Miller, MSW; NCNA Lobbyist This has been a very busy legislative session at the North Carolina General Assembly, but things have slowed down over the last few weeks as lawmakers dig into some big picture items like the budget and Medicaid Reform. Budget Debate Continues At the time of print, the House and Senate were negotiating budget components, hoping to pass a complete package by August 31. Because both the House and Senate versions included school nurse funding, NCNA feels confident the funding will be in the final document, but we continue to bring attention to the need. NCNA also continues to lobby for the language in House Bill 701/Senate Bill 640 to be included in the budget, authorizing the Legislative Research Commission to study school nurse funding during the interim. Medicaid Reform There has been little movement towards a compromise between the House and Senate, who favor very different approaches. The Senate plan released in August, however, has provider-neutral language that NCNA has been pushing for. The House rejected that plan, as expected, the two chambers convened a conference committee to negotiate a final bill. House Bill 807/Senate Bill 695 Modernize Nursing Practice Act Both bills remain in their respective chambers Health Policy Committee where most bills have been significantly overshadowed (and thus delayed) due to the Medicaid Reform debate. Because HB 807 and SB 695 remain eligible for consideration during the entire session (which will not end until sometime in the late summer or fall of 2016, roughly a year from now) there is no urgent deadline, though we continue to push for passage before the session adjourns for a break. We have repeatedly heard that the leadership in both legislative chambers wants to resolve the long-running debate over how to best reform the state s Medicaid program before taking up other healthcare-related issues. However, NCNA, allied organizations, and bill sponsors continue to work to have the bills heard as soon as possible, and to educate the General Assembly members on how increased access to excellent and lower-cost care could benefit their constituents, the healthcare budget, and the state as a whole. We will continue to push for the bills to be heard and the issues they address be included as part of all healthcare discussions taking place in Raleigh, on Medicaid, and beyond. House Bill 774 Restoring Proper Justice Act This bill allows a medical professional other than a physician (physician assistant, nurse practitioner, registered nurse, emergency medical technician or emergency medical technician-paramedic) to monitor an execution. Despite There are still many important issues to be decided this session and while there are many uncertainties, there is one thing that is certain: the need for nurses to be engaged in the legislative process is greater than ever. NCNA s public opposition, the bill was passed and signed into law on August 5. NCNA continues to believe that participation in executions should not be a required component of any nurse s job description and he/she should be able to object for ethical reasons without retribution or loss of employment. The bill also provides that while a physician is not required to be present at the execution, one must be on the premises and available to examine the body to pronounce the person dead, and must certify the fact of the execution to the clerk of superior court in the jurisdiction where the sentence of death was pronounced. Additionally, a controversial provision of the bill states that nothing in the Public Records Law is to be construed to require or authorize a public agency to disclose specified identifying information relating to the drugs or supplies obtained for executions. House Bill 13 Amend School Health Assessment Requirement This bill passed both the House and Senate, and went to the Governor s desk in August. Past NCNA President and current Rep. Gale Adcock was a signatory for the Conference Report continued on page 10 Fall 2015 Tar Heel Nurse 5

6 Convention is Almost Here! NORTH CAROLINA NURSES ASSOCIATION ANNUAL CONVENTION Nursing Practice, Education, and Leadership 2015 September 30 th - October 2 nd Up to 17.5 CHs, Professional Development, Future-Focused Discussions, Networking! Register now! Pre-Registration ends on September 21 st Embassy Suites Charlotte-Concord Golf Resort & Spa Concord, North Carolina Every nurse in North Carolina has some great reasons to attend NCNA s 2015 Annual Convention. Make plans now to join us in Concord, because we are expecting great things! Awesome Professional Development Opportunities NCNA s curriculum task force has done an incredible job of packing a lot of education into Convention this year, with speakers discussing the latest trends and important issues facing healthcare. Attendees can earn up to 17.5 contact hours. One of the most popular upgrades to the Convention schedule in recent years has been our Tracks setup for breakout sessions: choose speakers in the categories of Practice, Leadership, or Education that interest you most. This year, we re thrilled to bring in two nationally-recognized speakers: a keynote address from Susan Hassmiller, PhD, RN, FAAN, and an endnote from Victoria Rich, PhD, RN, FAAN. They are both widely known for their stellar presentations on the role of nurses in transforming healthcare and making the business case that demonstrates the bottom-line value of nursing best practices and staffing, respectively. Having just one of these speakers would have been great for attendees getting to see both is an exciting opportunity! Shaping the Future of Nursing Perhaps nothing is more important during Convention than our Membership Forum, when attendees get the chance to tackle some of the most pressing issues for the nursing profession. This year, we ll focus on three topics: The Institute of Medicine s Future of Nursing 80/20 recommendation Safety in the nursing workplace Technology innovations to benefit patient care This is your best chance to give NCNA s Board of Directors a roadmap for priorities you want to focus on, and it has quickly become one of the highlight CNE events of Convention each year! Preregister by September 21 online at or by calling Onsite registrations begin at 8:30 on September 30! NCNA member Tomika Williams on the 2014 Membership Forum: I really enjoyed the interaction at our tables, especially around the probing question about what NCNA should do. I think a lot of times we come up with ideas and then sometimes we don t give that feedback back...it made you think a little bit beyond OK, what s the problem? but what are our next steps? 6 Tar Heel Nurse Fall 2015

7 It s Election Season at NCNA! Polls are already open as we prepare to install new leaders at the 2015 Annual Convention on Friday, October 2. There are 11 seats on the Board of Directors up for election this cycle: President-Elect, Secretary/Treasurer, all eight Regional Directors, and the Chair of the Commission on Advanced Practice Nursing. Chairs of the Leadership Development Committee and Bylaws Committee are also up for a vote, along with the two ANA Membership Assembly representatives. Online voting is available for your convenience through 6:00 pm on Thursday, October 1st. Convention attendees can meet the candidates and vote onsite, as well. To read candidate profiles for everyone on the ballot, visit: To vote online, visit: Slate of candidates President-Elect Elaine Scherer Secretary/Treasurer Julie DelCasino Regional Director, Mountain Linda Comer Carrie Edgison Regional Director, Northeast Thompson Forbes Regional Director, Northwest* Regional Director, South Central Teresa Duncan Yolanda Hyde Regional Director, Southeast Lisa Davis Snow Regional Director, Southwest Tina Schoen Regional Director, Triad Lauren Crotts Regional Director, Triangle Septina Florimonte Audrey Neal Chair, Commission on Advanced Practice Nursing Dennis Taylor Chair, Leadership Development Committee Marion Braden Dena Evans Chair, Bylaws Committee Julia Aucoin ANA Membership Assembly Mary Graff Elaine Scherer *No Candidate Identified. Serving Those Who Served Us Duke University School of Nursing and the Durham VA Medical Center are proud to announce the creation of the VA Nursing Academy Program for students who are enrolled, or are enrolling in Duke s Adult Gerontology Primary Care Nurse Practitioner MSN Program. In this Veterans Health Specialty, Duke Nursing Students will participate in a veterans-centric program focusing on the unique health care needs of veterans and their families. Conduct clinical rotations in one of several Durham VA Medical Center facilities in North Carolina Participate in academic enrichment activities beyond traditional Adult Gerontology Curriculum Explore potential career pathways in Veterans Health Care Ability to apply for Post-Graduate Residency Duke School of Nursing s Doctor of Nursing Practice (DNP) Program For more information and to apply for this exciting opportunity, please visit nursing.duke.edu Fall 2015 Tar Heel Nurse 7

8 ANA Recap Congratulations Are in Order! By Tina Gordon, MPA, CAE, FACHE; NCNA Chief Executive Officer NCNA members represented North Carolina extremely well in Washington, DC, July as nurses from across the country convened for the American Nurses Association Membership Assembly and Lobby Day. Perhaps the highlight of the week for NCNA was the election of NCNA Past President Ernest Grant as Vice President of the American Nurses Association. This was a hotly-contested race with many qualified candidates on the ballot. Grant is well known to North Carolina nurses, as evidenced by the overwhelming response on Facebook when we first announced his win: 395 likes, 80 shares, and 100 comments! I know he will serve ANA very well. Also of note, he is the first male nurse elected to serve as Vice President of ANA. His term of office will begin January 1, In addition to Grant s impressive showing at the ANA meetings, NCNA President-Elect Mary Graff and Mountain Region Director Elaine Scherer served as the voting representatives from NCNA. Additionally, NCNA member Sharon Pearce was active through her role as President of the American Association of Nurse Anesthetists. The week got underway with over 260 nurses converging on The Hill to advocate for the profession and patients. It was the largest delegation in recent history. Simultaneously, approximately 2,000 nurses from around the country were taking action by calling their Congressional offices and speaking about the importance of Safe Staffing levels and Home Health legislation. Graff, Scherer, and I visited the offices of five members of the North Carolina Congressional delegation, including both Senators Burr and Tillis. The ANA Membership Forum continued to offer an engaging opportunity for dialogue about several timely nursing issues. Following discussion and input from membership assembly representatives, the Reference Committee made several recommendations. The membership assembly approved three recommendations, which you can see to the right. Fostering an Ethical Environment and Culture 1. Promote knowledge and application of the Code in a systematic and comprehensive way within nursing education programs and professional development. 2. Advance ANA s role as the premier organization fostering ethics within the nursing profession by infusing ethical content into ANA s core programmatic work. 3. Identify and promote best practices for ethical issue management to improve the ethical environment/culture. Infection Prevention and Control Issues in the United States 1. Engage with internal and external stakeholders to provide ongoing and just-in-time education about infection control and prevention and disaster response. 2. Support Constituent/State Nurses Association efforts to communicate, both internally and externally, during crisis situations. 3. Identify and disseminate innovative strategies to engage nurses in broad infection protection and disaster preparedness activities. Public Reporting: Advancing Patient Safety and Quality Care Advance quality measures and data policy to: 1. Include measures that capture nursing care in national public reporting efforts. 2. Analyze structured nursing data in data sets for use across care settings to improve quality outcomes. 3. Educate consumers and nurses regarding the value and use of quality data for informed decisionmaking. 8 Tar Heel Nurse Fall 2015

9 Speaking Up About Nursing with a Disability By Chris Cowperthwaite, APR; NCNA Manager of Communications & Outreach Since kindergarten, NCNA member Sharon Ying, RN, BSN, has been dealing with hearing loss. With the help of surgeries and hearing aids, however, it was manageable for a long time. She went to nursing school and kicked off a successful career working in UNC Health Care s Medical ICU. In 2008, the problem suddenly got worse. Ying was diagnosed with an autoimmune inner ear disease in her right ear, along with a perforated eardrum, chronically infected mastoid bone, and a benign Cholesteatoma tumor in her left ear. The deterioration in her hearing forced Ying to quit her beloved job. A short while later, a chance encounter helped get Ying back on her original career path. Ying ran into a physician she used to work with, and when she told him why she was no longer at UNC, he said, That s a shame. You used to be such a great nurse. Ying couldn t get the conversation out of her head. A couple days later, I was like, You know what? I still really am a good nurse! Ying said. I m just a good nurse who lost her hearing, but it doesn t negate everything I have to contribute as a nurse it just means I have to do it in a different way. With that attitude adjustment, Ying started exploring her options. She had the encouragement of her husband and the help of a bone-anchored hearing aid (BAHA) and decided to go back to school to earn her BSN. Ying said she felt rejuvenated, but quickly realized that her deafness would be a recurring issue when a classmate essentially excluded her from a group project because the group could move faster without her. That was really upsetting to me, Ying said. Whatever contribution I could have made just wasn t going to happen You know what? I still really am a good nurse! Ying said. I m just a good nurse who lost her hearing, but it doesn t negate everything I have to contribute as a nurse. because a person had decided I wasn t good enough because I couldn t hear. Despite some frustrations along the way, Ying graduated in She got a job at PPD as a medical nurse consultant, and simultaneously worked part time in the ICU at WakeMed Cary Hospital for a while. It really helped my confidence, because for a long time I thought, I could just never go back to the bedside. I mean, I m deaf! I can t work bedside anymore. And while it s definitely harder, it s definitely doable, Ying said. I had a great time at WakeMed Cary. Ying is now solely at PPD, where she says she has a supportive manager and access to things like a phone amplifier that help her do her job. Her hearing continues to worsen but she keeps finding ways to make it work. She is considering getting a cochlear implant in her left ear. The biggest problem that Ying sees with her situation isn t her disability it s the potential of that disability to overshadow the rest of her abilities. Sharon Ying continues to work with the help of a bone-anchored hearing aid (BAHA). The sound processor is seen here along with its titanium post, which is attached to her skull. continued on page 13 Fall 2015 Tar Heel Nurse 9

10 Providing Culturally Sensitive Care to NC s Montagnards By NCNA Member Donald Kautz, RN, PhD, CRRN, CNE, ACNS-BC; Robert Todd, RN, BSN; Carolyn O Brien, RN, BSN; and, Diu Siu Hartshorn, LPN There are approximately 10,000 Montagnards and their descendants living in the Raleigh, Greensboro and Charlotte areas of North Carolina. The Montagnards The authors have written an in-depth manuscript to assist nurses and other healthcare providers to provide culturally sensitive care, which is available on the family life, diet, and views on mental and physical heath. The aim is to help North Carolina nurses to provide culturally competent care to their Montagnard patients. This article explores the Montagnard culture and provides recommendations for physicians and nurses on Montagnard history, religious beliefs, family life, diet, and views on mental and physical heath. are an indigenous people of the Central Highlands of Vietnam, north of the Mekong Delta and inland from the China Sea. The northern edge of the Highlands is formed by the formidable Troung Son mountain range, and Montagnard is French for mountain people. There are approximately 54 different Montagnard tribes, and at least six different ethnic groups in the Central Highlands. The groups are generally divided by what mountain they live on. This also defines the language they speak. The tribes listed in order of size are Jarai, Rhade (or Ed), Bahnar, Koho, Mnong (Bunong), and Stieng. North Carolina Nurses Association website at One of the authors is a congregational nurse with 8 years of experience in serving the Montagnard community and another is a Montagnard. Information provided that is not cited comes from their life experiences. The in-depth article explores the Montagnard culture and provides recommendations for nurses and other healthcare providers on Montagnard history, religious beliefs, The Montagnards are unique populations who have mainly settled in North Carolina. They faced persecution and torture in their home country because of the Vietnam War. They value relationships and community. Nursing interventions should be aimed at developing trust, mutual respect, and a therapeutic relationship in order to ensure that patients get the most benefit out of each interaction. This can be done by using interpreters appropriately, allowing for adequate time, making proper assessments, and offering careful explanations. Finally, as in working with all cultures, letting Montagnards know you care and want to learn about their cultural norms will go a long way to correcting any cultural missteps. To read the full article visit GRE, GMAT, LSAT, SAT PREP Advance your career with a degree! Don't let entrance exams keep you from earning your degree. Attend prep classes throughout the triangle or via Live Online or Digital Video Recordings. The Early Bird fees are only $420 - $504 for 30 to 42 hour courses! PrepSuccess LLC partners with select programs of UNC, Duke, Campbell, FSU, Meredith, UNC-G, and Peace. / Legislative Update Many Unanswered Questions continued from page 5 for HB 13. The bill requires a health assessment form be filed within 30 days for any child s initial entry into a public school system not just Kindergarten as is the current law and lays out some additional requirements. Looking Ahead There are still many important issues to be decided this session and while there are many uncertainties, there is one thing that is certain: the need for nurses to be engaged in the legislative process is greater than ever. Please continue to utilize NCNA as your resource for legislative information and support our unified efforts to move North Carolina forward through better access to quality care and better utilization of nurses in our state. 10 Tar Heel Nurse Fall 2015

11 Attitude is Everything It s Not About Me!! By NCNA Member Joseph Hackett, BSN, RN New graduates from nursing school should evaluate their attitude and work philosophy as they begin their first job within the health care profession. Graduates should consider the dynamics of the facility in which they are applying. The facility can have an effect on a nurse s attitude. of nurses and their survival. According to Cho, Lee, Mark & Yum (2012, p. 63), dissatisfaction with interpersonal relationships, work content and physical work environment was associated with a significant increase in the hazards of leaving the first job. This has a According to Cherry & Jacobs (2014), new nurses should have an open mind. We do not need to be set in stone or so inflexible. This attitude of openness will give us the chance to look at issues beyond our boundaries, skills and abilities and opportunities to explore Nursing schools prepare you for the health care profession; however, organizational dynamics shapes the future of a nurse s performance and attitude. The social learning theory supports the idea that if a person is exposed to an environment for a period of time, they will take on the norms of said environment (Halgin & Whitbourne, 1994). Attitude is everything and taking the time to evaluate the alignment of one s personal attitude and philosophy with the organizational dynamics can mean everything for a successful work relationship. The new nurse s ability to transition into a valued professional nurse is essential to the facility, the patient and the community. According to Maxwell, Brigham & Smith (2011) one of the biggest obstacles facing new nurses is the learning of who is who, who does what and working within the organization. These three factors have a tremendous effect on the attitudes Nursing schools prepare you for the health care profession; however, organizational dynamics shapes the future of a nurse s performance and attitude. significant impact on the attitudes of new nurse s which correlates to higher turn overs within the profession. In fact, according to Maxwell, Brigham & Smith (2011, p. 67), high turnover rates of new graduate nurses, 17.7%, 33.4 % and 46.3% were estimated to leave the job within 1, 2 and 3 years. Why is it nurse s attitudes changes? Just as Maxwell, Brigham & Smith (2012) mentioned in their study, nurses are full of anticipation and excitement. The same is true for this RN. New RNs have high ideals and standards. Then reality sets in. New RNs have to come to the realization: we joined the Health Care Profession. The Health Care Profession did not join us. There is the friction of it all. which we may not have had within school (Cherry & Jacobs, 2014). The only way this will happen is IF we humble ourselves and permit ourselves to remember the real reason we chose this profession which is to serve our fellow man. Cherry & Jacobs (2014 p. 474) states the ANA social policy statement, Nursing is the protection, promotion and optimization of health and abilities Attitude is a double edge sword. When it is used correctly it is a mighty weapon which benefits everyone; however, the opposite is true. Just as an apprentice blacksmith learns to use his tools and mold this double edge sword into a great work of craftsmanship, we as nurses must learn to use our craft. STILLPOINT ACUPUNCTURE Transforming lives through the power of Chinese Medicine / There are many variables involved regarding attitudes. The three mentioned earlier from the study by Cho, Lee, Mark, & Yun (2012) with regards to dissatisfaction of interpersonal relationships, work content and physical work environment are the key factors to the change in attitudes of nurses. How do we ensure our new nurses are not caught up in the negative influences from within the workplace? Organizational dynamics can mold the future nurse in place, as well as their performance. The social learning theory supports the idea we learn from our association and observation of others over a period of time. If a nurse is continuously exposed to these continued on page 16 Fall 2015 Tar Heel Nurse 11

12 2015 Leadership Academy Wrapping Up The 13 members of NCNA s Leadership Academy gave their final project presentations in August, capping a successful 2015 spent honing leadership and communication skills. Past NCNA President Ernest Grant, NCNA President Elect Mary Graff, and several Leadership Academy graduates from previous classes were on hand to serve as a review panel, and it offered a unique opportunity for an insightful Q&A session. The class divided into three groups to focus on specific projects aimed at improving the nursing profession from within: The Benefits of Legislative Advocacy What is a NURSE? Spreading the Word: Extending Leadership Development to Your Peers This year s class will officially graduate on Thursday, October 1 during the Awards Luncheon at NCNA s 2015 Annual Convention. Members of the 2015 Leadership Academy pose after giving their final presentations in August. The application period for the upcoming 2016 class is open from September 1-November 1. For an application go here: Healthcare Highlights From NCNA s E-Newsletters ANA Issues New Immunization Position Statement The American Nurses Association has updated its position on vaccines for nurses. The recommendation is for all individuals, including registered nurses, to be immunized against vaccinepreventable diseases, with the only exemptions being for medical or religious reasons. Happy 50th Anniversary, Medicare & Medicaid! ANA President Pamela Cipriano used the 50 th anniversary of Medicare and Medicaid as an opportunity to talk about updating the ways that nurse training funding is allocated at the federal level. We re seeing mixed signals today in the nurse employment market, she said. There have been layoffs by some hospitals at the same time that registered nurse ranks as the most advertised position nationwide. Study: Patients in Rural NC Get Less Follow-Up The Triangle Business Journal highlighted a study by RTI International and UNC-Chapel Hill that shows the disparity in follow-up care between Medicare patients in rural and urban settings. The research shows that rural patients are more likely to use Emergency Departments, even if they had recently been admitted to the hospital. Researchers Say Nurses and Physicians Often Work While Sick New research published in JAMA Pediatrics shows that 83 percent of healthcare workers had come to work while sick, even though those same workers acknowledge it could harm patients. Physicians were more likely than nurses to show up to work sick, but more than 70 percent of nurses said they would work with a cough. 12 Tar Heel Nurse Fall 2015

13 Conover Expands on APRN Research Dr. Chris Conover recently gave a presentation at the Duke University School of Nursing that was focused on his study, Economic Benefits of Less Restrictive Regulation of Advanced Practice Registered Nurses in North Carolina. This research, which was commissioned by NCNA, shows that, at minimum, North Carolina would see a savings of nearly $500 million each year if the state were to allow Full Practice Authority for APRNs. Dr. Conover s study also found that these changes would allow APRNs to alleviate some of the state s impending access-to-care gaps as the need for more primary care providers increases. The research has been vital in helping advocate for modernized APRN regulations at the North Carolina General Assembly. To watch a video of Dr. Conover s presentation, visit Dr. Chris Conover addresses attendees at the Duke School of Nursing on May 26. Speaking Up About Nursing with a Disability continued from page 9 What I find really interesting about being a nurse, or probably any kind of healthcare provider, is that if you have a disability, you don t want to talk about it, Ying said. Ying says there are all sorts of reasons that people keep quiet about their disabilities: the fear of losing your job or the fear of missing something with a patient, for example. But Ying says it is vital that good nurses with disabilities be given the opportunity to prove their value. If you truly understand a patient s disease process, you are an asset for that patient. You could be an excellent nurse, but maybe you have a problem with your hand, Ying said. Somebody can put in that IV for you, and that doesn t negate the experience and the compassion that you could bring to patient care. She wishes more nurses would speak up about their disabilities, because she worries that too many try to hide it. That could just exacerbate the problem. Workplaces, including healthcare facilities, are required to make a reasonable accommodation for people with disabilities, and Ying says it is important for nurses with disabilities to advocate for themselves if they need something to help make a meaningful contribution. They re not going to redesign the whole hospital for you, Ying said with a laugh. But she went on to stress that those reasonable accommodations are not just a federal requirement, but something that can encourage great nurses to reach their full potential. She is quick to point out there is a shortage of healthcare providers and the profession needs all the good nurses it can get. Ying almost left the profession too soon, and she hopes others don t regret following through with that same decision. Do you have a nursing-specific human interest story that NCNA members might find interesting? your story idea to Chris Cowperthwaite at chriscowperthwaite@ncnurses.org. Fall 2015 Tar Heel Nurse 13

14 Hypertension Self-Management Support in Primary Care: A DNP Quality Improvement Project and a Charge for Leadership and Advocacy with the Million Hearts By NCNA Member Jean Ann Davison, DNP, FNP-BC; NCNA DNP Council Cardiovascular disease (CVD) causes one in three deaths in the United States (US) and is the most common adult diagnosis seen in primary care. The American Heart Association (AHA) projects that by 2030, 40.5% of the US population will have some form of CVD, with an estimated cost to the national health care system of $1 trillion per year. [1] The US Department of Health and Human Services (HHS) launched the national Million Hearts initiative in 2011 with a goal to prevent 1 million heart attacks and strokes in 5 years with strategies directed at the leading modifiable risks for CVD. The focus of this campaign is to empower Americans to make healthy lifestyle choices for global CVD risk reduction and to improve outcome goals in the ABCS: A=Aspirin therapy for people at risk, B=Blood pressure control, C=Cholesterol control, S=Smoking cessation and sodium reduction. [1] Hypertension (HTN) is the most independent and modifiable risk factor for CVD, stroke, congestive heart failure, and chronic renal disease. [2] Approximately 31% of US adults have HTN, with studies suggesting that a 10% increase in treatment of HTN could prevent 14,000 premature deaths each year among adults less than 80 years of age. The goal of the Million Hearts campaign is that 65% of the US population will have a BP<140/90 mmhg by 2017; as of 2012, only 52% of the US population had BP controlled to <140/90 mmhg. [3] Evidence based guidelines for hypertension control stress the importance of self-management support. Selfmanagement support is also a key meaningful use measure for implementing a patient center medical home. As a DNP student, I led a quality improvement (QI) study designed to improve the clinical performance of hypertension (HTN) management that focused on self-management support (SMS) among adult patients at a primary care clinic with a high rate of CVD. Using a team-based approach, interventions included staff QI training along with patient education and lifestyle goal setting for SMS of HTN. The design included retrospective baseline of meaningful use population data (N=1,210) generated six months prior to study start date and an analysis of the data during the six-month QI study (N=1,409). The electronic medical record data included blood pressure, cholesterol, tobacco use, body mass index, and self-management goals. SMART goal setting with the patient and the proactive team members focused on heart healthy eating, aerobic physical activity, weight loss, tobacco The ABCS of Million Hearts outcome goals: A = Aspirin therapy for people at risk B = Blood pressure control C = Cholesterol control S = Smoking cessation and sodium reduction cessation, moderate alcohol consumption, stress reduction, medication adherence, home BP monitoring, and, as applicable, blood sugar control. The primary objective, >80% of adults would have documented self-management goals, was achieved and significantly improved from a baseline of 62% to 83% (p=0.008) during the 6 month QI intervention. I have been fortunate to present this QI project and the million hearts strategies at NCNA s Nurse Practitioner Spring Symposium, nationally with the Institute for Health Care Improvement and internationally at the Athens, Greece Institute for Education and Research. Also, I am chairing a NC Million Hearts Blood Pressure Affinity QI Collaboration in which we are planning a statewide Learning and Action Network (LAN) Session on October 7, 2015* with the purpose to broaden the number of people/organizations engaged to reaching the Million Hearts goal. Nurses have an important role as advocates and leaders in meeting the current demand for HTN management and supporting patients in self-management. Some recommendations from my QI project and the Million Hearts to reduce CVD include: Patient-centered medical homes should use the team-based approach and evidence based guidelines. SMS goal setting should be a part of every patient s office visit and included in the EMR. Patient assistance with medication should be offered for adherence. continued on page Tar Heel Nurse Fall 2015

15 North Carolina Chiefs of the United States Army Nurse Corps By NCNA Members Olivia Jenkins, RN, MSN and Phoebe Pollitt, RN, PhD; Nursing History Council Chair and Vice Chair The Spanish American War of 1898 was the first war in which the US Army hired graduate nurses to serve on a contract basis. Their work saved many lives and in 1903 the US Congress established a permanent US Army Nurse Corps (USANC). Thousands of nurses have served USANC, at home and overseas, during times of war and peace. Three nurses from North Carolina have directed the USANC as Chief Nurse, overseeing thousands of nurses in hundreds of hospitals, clinics, and battlefield MASH units across the globe. Brief information about each one, in chronological order, is given below. Longtime NCNA member Mildred Irene Clark was born on January 30, 1915 in Elkton, North Carolina. In 1938, after earning her Nursing Diploma from the Baker Sanatorium Training School for Nurses in nearby Lumberton, Clark enlisted in the USANC. The USANC sent Clark to anesthesia school at the Jewish Hospital in Philadelphia, Pennsylvania. After graduating in 1940, Clark was ordered to Pearl Harbor, Hawaii for service at the Army Hospital at Schofield Barracks. When the Japanese attacked US Forces at Pearl Harbor on December 7, 1941, Clark ran from her barracks to the hospitals and did not leave the hospital for almost three weeks. During that time she delivered anesthesia to hundreds of men prior to their surgeries and nursed the wounded postoperatively. Clark was appointed as Chief of the Army Nurse Corps in 1963, and soon established the USANC s requirement that all nurses earn bachelor s degrees. Under Clark s leadership, male nurses began receiving commissions in the Army. In 1999, the US Army dedicated the Mildred I. Clark Health Clinic, its first building named in memory of a woman, at Fort Bragg, NC. Clara Mae Leach Adams-Ender was born on July 11 th, 1939 in Willow Springs, North Carolina to a family of sharecroppers. In the fall of 1956, Adam-Ender entered the North Carolina Agricultural and Technical College (NCA&T) in Greensboro, NC. While there, she joined the Army ROTC to help pay her nursing school expenses. Adams-Ender participated in the Sit-In movement for racial integration while a student at NCA&T. and Sciences from the Army Command and General Staff College at Fort Leavenworth, KS. Adams-Ender became Chief of the Army Nurse Corps in 1987, the second African American to hold the post. She retired in 1993 as the commanding general of Fort Belvoir, Virginia. She was an NCNA member when she became the first nurse to serve as Surgeon General and Commanding General of the United States Army Medical Command. Major General Patricia Dallas Horoho was born in 1960 to a military family in Fayetteville. She was an NCNA member when she became the first nurse to serve as Surgeon General and Commanding General of the United States Army Medical Command. Horoho earned her BSN at UNC-CH in 1982 and soon entered the USANC. Ten years later she earned an MSN from the University of Pittsburgh and another Master s Degree in National Resource Strategy from the Army s Command and General Staff College. Horoho s bravery, leadership skills and nursing skills were evident while she cared for disaster victims at both the Green Ramp disaster at Fort Bragg in 1994 and during the 9/11 attack on the Pentagon. She served as the Chief of the USANC from She is the first nurse to become a Surgeon General and Commanding General of the United States Army Medical Command. Each of the Chiefs of the USANC from NC has been honored by many civilian and military organizations. NCNA is proud of all the Tar Heel nurses who have served the country and its troops. Upon graduation in June 1961, she decided to make Army nursing her career. In 1969, she earned an MSN from the University of Minnesota and in 1976 she became the first African American to earn a Master s Degree in Military Arts Fall 2015 Tar Heel Nurse 15

16 Attitude is Everything It s Not About Me!! continued from page 11 challenges while being inflexible and the organization does not provide proper guidance, there will not be a change in the future generations of nurses. The professional shortage will continue to grow and turnover rates will rise. A person who is educated rather than trained will have the ability to analyze, interpret, make sound judgments and will not be dependent on others to make the decision. An individual who is open minded to their profession & organization will have more doors opened to their future rather than someone who is closed minded and inflexible. An individual who is open minded to their profession and organization will have more doors opened to their future rather somone who is closed minded and inflexible. Cherry, B., & Jacob, S. R. (2014). Contemporary nursing: Issues, trends & management (6 th Ed). St. Louis, MO: Mosby/Elsevier. environment in the state of North Carolina (Unpublished Master s Thesis). Central Michigan, Mt. Pleasant, M.I. References Brewer, C.S., Kovner, C. T., Greene, W., Tukov-Shuser, M. & Djukic, M. (2012). Predictors of actual turnover in a national sample of newly licensed registered nurse employed in hospitals. Journal Of Advanced Nursing 68 (3), Doi: / j x Cho, S., Lee, J., Mark, B. A. & Yum, S. (2012). Turnover on New Graduates Nurses in Their First Job Using Survival Analysis. Journal of Nursing Scholarships 44(1), Doi: / j x Hackett, J. L. (2000). Job satisfaction: a two way dilemma or a legal one way street in a correctional officer s Maxwell, C., Brigham, L., & Smith, A. (2011). Challenges facing newly qualified nurses: a qualitative study. British Journal Of Community Nursing, 16 (9), Halgin, R., & Whitbourne, S. (1994). Abnormal psychology. Dubuque: Brown-Benchmark. Hypertension Self-Management Support in Primary Care continued from page 14 Opportunity for group and community supported heart healthy activities should be offered. Policies and resources for safe exercise environments, healthy food options and tobacco prevention/cessation programs should be supported. By implementing these strategies then prospectively monitoring for improvements in the ABCS and weight reduction, our nation should achieve the Million Hearts goal. *(For more information on strategies or the free October 7 th NC LAN Session, contact Davison@unc.edu) References 1. Tomaselli, G., et al., The American Heart Association and the Million Hearts Initiative. Circulation, (16): p U.S. Department of Health and Human Services (HHS). Million Hearts [cited 2012 June 1]; Available from: millionhearts.hhs.gov/index.html. 3. Ritchey MD, W.H., Gillespie C, George MG, Jamal A Million hearts: Prevalence of leading cardiovascular disease risk factors - United States, , in Morbidity and Mortality Weekly Report 63(21): Tar Heel Nurse Fall 2015

17 In Your Corner Evolving Healthcare Landscape By NCNA Member Colleen Burgess, EdD, PMH, CNS-BC; Professional Practice Advocacy Council (PPAC) Co-Chair PPAC has received a number of concerns in the past few months about the flux and atmosphere in the healthcare environment. It is no wonder we are feeling the heat inside and out in NC. The changes in healthcare are occurring simultaneously at each and every level of healthcare delivery and impact the entire arena in which we all practice. Consider for a moment the changes we already know that range from reduction in our own personal coverage and insurance, reimbursement issues for our families and patients, restrictions on services and third party reimbursement, cost containment, increasing copays, to the impact of ACA, Medicare and Medicaid reductions, and accountability, just to mention a few. Nurses are experiencing the ripple effect of the stressors that accompany the magnitude changes. Many of these pressures have resulted in the elimination and or redesign of job responsibilities with an aura of do more with less. Historically, it is well documented in the literature that nurses experience the gamut of desperate behaviors such as incivility, bullying, group oppression and lateral violence. Much of the uncivil behaviors experienced by nurses are associated with these complex pressures. We are not alone in the experience of frustration in the workplace, as Michael Brooks famous quote captures the tone: Desperate people do desperate things. In light of the aforementioned stressors and reports to PPAC, where do we go from here? NCNA is moving forward to support you through these challenging times. Many of your nursing friends, colleagues, and leaders are rolling out opportunities for members. We are continuing to build an advocacy force for you (PPAC). Nurse leaders on this committee welcome you to participate with them. We are providing workshops, coping skills, and an entire Nurses Transforming Nursing (NTN) framework to assist you with coping skills. Magic happens when you combine collective caring and the support of fellowship. Share your story through Nurses Transforming Nursing. Go to the NCNA website and click on the NTN tab to share your Successful Coping Story. Here are a couple of mine. bullied, or afraid, I have shown up for decades. Circle the wagons interpreted by me as surround yourself with bunny rabbits not porcupines and don t walk into swinging bats. Know that feelings are contagious. You have a choice of where you hang out if you want to be angry, depressed or afraid, pick your company at work. Stick with the winners; my definition of winning is coping in a Stick with the winners; my definition of winning is coping in a self-constructive healthy and holistic manner. self-constructive healthy and holistic manner. My story does not take the skills of a rocket scientist and may seem quaint or passé. It is called reframing your life with the energy you seek. Keeping it very simple for me helps in a complex chaotic environment. I love aesthetics; eye candy feed your heart candy. What simple thing feeds your heart and passion? Do tell us your strategies for weathering these turbulent times. PPAC will collect the stories and present a story board with your contribution in the exhibit hall at NCNA s annual convention in October. Be an advocate for professional practice and share your story! In Your Corner has been created by the NCNA PPAC to specifically address workforce advocacy issues that nurses in NC face. We invite you to participate by sending us ideas of what you would like to see in this column, or specific questions you have related to workforce issues. We will reach out to an expert in the subject of question and publish the answers in the next column. Please submit questions or ideas to: Penny Sauer (sauerp@uncw.edu) or Dona Caine Francis (donacaine@bellsouth.net). I have gotten used to pulling up my coping coupons given to me over the years from wonderful nurse colleagues. One of the best that I cash in frequently is to suit up and show up for life and work. No matter how hurt, devastated, Fall 2015 Tar Heel Nurse 17

18 Member News Past NCNA President and current North Carolina State Rep. Gale Adcock was featured in a recent Triangle Business Journal article about the onsite health center she oversees at Cary s SAS Institute. Anne Brown, Laura Carmon, Renee Cherry, Debbie Daniels, Barbara Dotson, Nadine Hardin, Sonya Hardin, Ryanne Hill, La Monica Hunter, Yolanda Hyde, Karen Kubecka, Wanda Martin, Nancy Marzolf, Andrea Novak, Paul Perryman, Tracey Whitley, Mary Wright, and Vanessa Zito have all been named to the Great 100 Nurses. They will be honored with the rest of the 2015 winners at a gala on October 17. Britney Broyhill, Dennis A. Taylor, and Mary Ann Wilcox were recently published in Nurse Leader. Their study, entitled The Lifecycle of the Advanced Clinical Practitioner, focused on Carolinas HealthCare System s efforts to transform its approach to educating, recruiting, retaining, and deploying advanced practice professionals. Do you have member news to report? NCNA is always interested in what its members are doing and working on. If you have something newsworthy that the entire membership might find valuable, please Chris at chriscowperthwaite@ncnurses.org. Ethan Cicero has been selected as one of 46 nurses from across the nation by the Robert Wood Johnson Foundation (RWJF) to be part of the second cohort of the Future of Nursing Scholars program. Cristina Hendrix and Tracey Yap are among the 163 inductees of the 2015 American Academy of Nursing fellows. They will be inducted on October 17. Honey Jones has been selected as one of 12 nurses to participate in the second cohort of the American Association of Nurse Practitioners Leadership Program. Randolph Rasch has been appointed as the Dean of the Michigan State University College of Nursing. Despite moving out of state, he plans to maintain his NCNA membership. Staff News Chris Cowperthwaite, NCNA s Manager of Communications and Outreach, recently earned his Accreditation in Public Relations (APR). The accreditation program is administered by the Universal Accreditation Board, comprised of nine public relations organizations. To earn this designation, candidates must successfully pass a comprehensive examination and also present a detailed case study to a Readiness Review panel of peers. Professionals earning the APR must maintain their credential through continuing professional development. Calendar of Events Sept NCNA New Member Orientation Webinar, 10:00am Sept FREE CE! NCNA Triad & Northwest Region CE Event: Mixing the Five Generations in the Workplace, Iredell Mem Hospital, 6:00pm, 1.0 CH Sept NCNA Regional Leaders Conference Call, 3:00pm Sept FREE CE! NCNA Mountain Region CE Event: The Dollars and Sense of Nursing Finance, MAHEC - Asheville, 8:00am, 3.5 CH Sept FREE CE! NCNA Northeast Region CE Event: Human Trafficking When Treating Patients, Hilton Greenville, 6:30-8:00pm, 1.0 CH Sept NCNA Board of Directors at Convention, 5:30pm Sept NCNA Annual Convention begins in Concord Oct 1... NCNA Southwest Region Evening Reception at Convention Oct FREE CE! NCNA Southeast Region, Legislative Update, SEAHEC, 6:30pm, 1.0 CH Nov 6... NCNA DNP Council Educational Event, 10am-1pm, Paragon Bank, Raleigh Nov NCNA Triad Region Meeting Nov Career Booster, Advocacy in Nursing: Navigating the Waters, Raleigh, 4.0 CH Nov NCNA Commission on Advanced Practice Nursing, 9:30am-12:00pm, Paragon Bank, Raleigh Nov NCNA Council on Nursing Informatics, 10am-3pm, Paragon Bank, Raleigh PLAN AHEAD: April 3-6, 2016, NCNA Nurse Practitioner Spring Symposium, April 3-6, 2016, Wilmington, NC September 28-30, 2016, NCNA Annual Convention, Benton Convention Center, Winston-Salem, NC March 26-29, 2017, NCNA Nurse Practitioner Spring Symposium, March 26-29, 2017, Asheville, NC 18 Tar Heel Nurse Fall 2015

19 Upcoming CE Opportunities The following is a list of CE events available to all RNs through paid registration (NCNA members get a reduced rate!). Note that there are still region-specific CE opportunities listed in the calendar, as well, that are free for NCNA members. September 30-October 2 NCNA 2015 Annual Convention (16.0 CH) November 13 Career Booster, Advocacy in Nursing: Navigating the Waters, featuring keynote speaker Past ANA President Rebecca Patton, a long-time champion for the nursing profession (4.0 CH) January 22-23, 2016 Annual NCNA Psych Retreat, Greensboro, NC, Embassy Suites Airport Hotel (CH TBD) Registration information for all CE events is available at The North Carolina Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation. Fall 2015 Tar Heel Nurse 19

20 PO Box Raleigh, NC Nursing Forward Non-Profit Org. U.S. POSTAGE PAID Raleigh, NC Permit No Tar Heel Nurse Fall 2015