Texas Nurses Association - Arthur L Davis Publishing

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Quarterly circulation approximately 303,000 to all RNs, LVNs, and Student Nurses in Texas. 

Texas Women’s Health Care in Crisis 

by Stacey Cropley, DNP, RN, CPN 

Access to preventive health care is critically 

important to the health and well-being of 

women and their babies. As nurses, we know 

that preventive care detects health problems, 

facilitates early treatment, helps women prepare 

for a healthy pregnancy, and helps with family 

planning. 

Currently, Texas has two programs that 

provide these services for low-income women: 

the Department of State Health Services (DSHS) 

Family Planning Program and the Women’s 

Health Program (WHP). In 2011, over 300,000 

low-income women received essential health 

care from the DSHS Family Planning Program 

and the WHP. For many women, these programs 

are their only contact with a health care 

provider. 

However, also in 2011, the Texas Legislature 

deeply cut funding to the DSHS Family Planning 

Program. As a result, at least 53 women’s health 

care clinics have closed, cutting off preventive 

care to women who previously used the 

program. In addition, the WHP is at risk due to 

the state rule excluding specific providers. The 

programs may no longer have the physicians, 

clinics, and other health care providers who can 

meet the growing demand for services. 

The WHP also lost its federal designation 

and along with it, more than $30 million in 

federal funding each year. The public health 

consequences for Texas women as a result 

of these cuts are severe (Table I). Texas must 

quickly rebuild the women’s health safety net, 

recognizing that preventive care saves lives and 

money. 

Lawmakers must restore funding to women’s 

health care in 2013, ensure ample capacity 

of providers, and rebuild the Texas women’s 

health care safety net. Swift action is needed to 

reduce fiscal costs and save taxpayers’ dollars 

while ensuring the health and well-being of low 

income women and their babies. 

Texas Nurses Association is proud to support 

the Texas Women’s Healthcare Coalition, a 

statewide coalition dedicated to improving the 

health and well-being of women, babies, and 

families by assuring all Texas women access 

to preventive care. For more information or to 

become involved in advocating for women’s 

health care, go to www.TexasWHC.org. 

Table 1: Health Consequences for Texas 

Reduced access to women’s preventive care 

means more undetected cases of: 

• Breast Cancer 

• Cervical Cancer 

• Diabetes 

• High Blood Pressure 

• Sexually Transmitted Infections 

• Depression 

• Family Violence 

Health Consequences for Texas: continued on page 4 

Join the 

Texas Nurses Association 

Today! 

current resident or 

Presort Standard 

US Postage 

PAID 

Permit #14 

Princeton, MN 

55371 

Application 

on page 18 

Inside this Issue 

CNE Workshops, 2013. ................ 4 

Follow the Status of Priority Bills 

for Nursing. ....................... 4 

Nursing’s Workplace Advocacy Legislative 

Agenda. .......................... 7 

Cancer Control ...................... 8 

Texas Health Steps: An Update. .........13 

Helping Caregivers Maintain Their Own 

Health. ...........................14 

TNA Leadership Conference. ...........15 

Nurses Taking Action in Texas: A Series ...17 

TNA Membership Application. ..........18

Page 2 • Texas Nursing Voice April, May, June 2013 

Texas Nurses Association Districts and Presidents 

Presidents of the 28 statewide Districts of Texas Nurses Association, as well as some District offices, are listed below. 

They invite you to contact them with questions or comments about TNA District membership and involvement in your 

local areas. For specific District locations, please refer to the TNA Tri-Level Membership District map on page 18. 

District 1: 

Laura Sarmiento 

Phone: 915.588-3173 

E-mail: 

laurasarmiento01@aol.com 

District 2: 

Helen Reyes 

Phone: 806.651-2631 

E-mail: hreyes@wtamu.edu 

District 3: 

Dennis Cheek 

Phone: 817.201-3334 

E-mail: d.cheek@tcu.edu 

District Address: 

Palli Stubbs 

P.O. Box 16958 

Ft. Worth, TX 76162 

Office: 817.249-5071 

E-mail: tna3@usapathway.com 

Website: www.tna3.org 

District 4: 

Frances (Frankie) Phillips 

Phone: 214.857-1487 

E-mail: frances.phillips@va.gov 


Pat Pollock 

P.O. Box 764468 

Dallas, TX 75376 

Office: 972.435-2216 

E-mail: d4tna@flash.net 

Website: www.tnad4.org 

District 5: 

Jen Collins 

Phone: 512.663-9181 

E-mail: 

jencollinsjencollins@ 

yahoo.com 


District 6: 

Paula Stangeland 

Phone: 409.741-1667 

E-mail: 

pstangeland9@gmail.com 


District 7: 

Deborah Daniel 

Phone: 254.982-0057 

E-mail: deborah.daniel@va.gov 


P.O. Box 1475 

Belton, TX 76513 

District 8: 

Sarah Williams 

Phone: 210.829-6092 

E-mail: williajs@uiwtx.edu 

Website: www.texasnurses. 

org/districts/08/ 

District 9: 

Terry Throckmorton 

Phone: 713.277-9870 

E-mail: 

tthrockmorton@chamberlin.edu 

District Office: 

Melanie Truong 

2370 Rice Blvd., #109 

Houston, TX 77005 

Office: 713.523-3619 

E-mail: tna9@tnadistrict9.org 

Website: www.tnadistrict9.org 

District 10: 

Helen Woodson 

Phone: 254.723-8719 

E-mail: 

Helen.Woodson@va.gov 

District 11: 

Marcy Beck 

Phone: 940.766-5362 

E-mail: marcy.beck@mwsu.edu 

District 12: 

Gerald Bryant 

Phone: 409.212-5006 

E-mail: 

gerald.bryant@bhset.net 

District 13: 

Vacant 

www.nurse-lawyer.com 

PROTECT YOUR LICENSE!! 

If you have received: 

• Letter of Investigation from the 

Texas Board of Nursing 

• Notice of Peer Review 

Contact Joyce Stamp Lilly RN JD 

713-759-6430 or jslilly@nurse-lawyer.com 

Registered Nurse and Attorney 

Call today, delay is not an option! 

District 14: 

Joe Lacher 

Phone: 956.882-5089 

E-mail: joe.lacher@utb.edu 

District 15: 

Andrea Kerley 

Phone: 325.670-4230 

E-mail: akerley@ 

hendrickhealth.org 



District 16: 

Mimi Baugh 

Phone: 325.659-7427 

E-mail: mimibaugh@angelo.edu 

District 17: 

Eve Layman 

Phone: 361.825-3781 

E-mail: evelayman@yahoo.com 



District 18: 

Mary Anne Hanley 

Phone: 806.252-1505 

E-mail: 

mahanley@att.net 



District 19: 

Tara Patton 

Phone: 903.391-1153 

E-mail: 

power4nurses@gmail.com 



District 20: 

Debbie Pena 

Phone: 361.212-0355 

E-mail: Debbie.pena@ 

victoriacollege.edu 

District 21: 

Rebekah Powers 

Phone: 432.685-1111 

E-mail: Rebekah.powers@ 

midlandmemorial.com 

District 22: 

Toni McDonald 

E-mail: 3tmcdonald@ 

windstream.net 

District 25: 

Inger Zerucha 

Phone: 903.315-2632 

E-mail: zinger65@sbcglobal.net 

District 26: 

Esmeralda Garza 

Phone: 956.878-6201 

E-mail: tacuaro48@yahoo.com 

District 28: 

Jenny Wilder 

Phone: 903.826-2712 

E-mail: 

jennyrwilder@gmail.com 

District 29: 

Tina Cuellar 

Phone: 409.772-8217 

E-mail: ehcuella@utmb.edu 

District 35: 

Kim Gatlin 

Phone: 903.466-6982 

E-mail: kgatlin@ntcc.edu 

District 40: 

Contact TNA 

Phone 800.862-2022 ext. 129 

E-mail: 

brichey@texasnurses.org 

www.texasnurses.org 

Published by: 

Arthur L. Davis 

Publishing Agency, Inc. 

TEXAS NURSING Voice 

A publication of Texas Nurses Association 

April, May, June 2013 

Volume 7, Number 2 

Editor-in-Chief – Ellarene Duis Sanders, PhD, RN, NEA-BC 

Managing Editor – Joyce Cunningham 

Creative Communications – Deborah Taylor 

Circulation Manager – Belinda Richey 

Editorial Contributors 

Carol Cannon, BSN, RN, OCN; Stacey Cropley, DNP, RN, 

CPN; Joyce Cunningham; Laura Lerma, MSN, RN; 

Joyce Pohlman; Ellarene Duis Sanders, PhD, RN, NEA-BC; 

and Joni Watson, MBA, MSN, RN, OCN 

Editorial Advisory Board 

Stephanie Woods, PhD, RN, Dallas 

Jose Alejandro, MSN, RN, MBA, CCM, Dallas 

Patricia Allen, EdD, RN, CNE, ANEF, Lubbock 

Sandra Kay Cesario, PhD, RN, C, Pearland 

Jennifer D.M. Cook, PhD, MSN, RN, San Antonio 

Thelma L. Davis, LVN, Giddings 

Anita T. Farrish, RN, MHSM, NE-BC, Waco 

Patricia Goodpastor, RN, The Woodlands 

Patricia Holden-Huchton, RN, DSN, Denton 

Tara A. Patton, BSN, RN, Palestine 

Dianna Lipp Rivers, RN, CNAA, BC, Beaumont 

Executive Officers 

Margie Dorman-O’Donnell, MSN, RN, President 

Karen Lyon, PhD, APRN, ACNS, NEA, Vice President 

Claudia Turner, MSN, RN, Secretary-Treasurer 

Regional Directors of Texas Nurses Association 

June Marshall, DNP, RN, NEA-BC – North Region 

Eve Layman, PhD, RN, NEA-BC – South Region 

Kim Belcik, BSN, RN-BC – Central Region 

Viola Hebert, MA, BSN, RN – East Region 

Jo Rake, MSN, RN, CNAA – West Region 

Executive Director 

Ellarene Duis Sanders, PhD, RN, NEA-BC 

TEXAS NURSING Voice is published quarterly – 

January, February, March; April, May, June; July, August, 

September; and October, November, December by – 

Texas Nurses Association, 8501 North MoPac Expy, 

Suite 400, Austin, TX 78759. 

Editorial Office 

TEXAS NURSING Voice, 8501 North MoPac Expy, 

Suite 400, Austin, TX 78759 

512.452-0645, e-mail tnveditorial@texasnurses.org 

Address Changes 

Send address changes to 

Texas Nurses Association, 8501 North MoPac Expy, 

Suite 400, Austin, TX 78759 

e-mail: tnvcirculation@texasnurses.org 

Advertising 

Arthur L. Davis Publishing Agency, Inc., 

517 Washington St. 

P.O. Box 216, Cedar Falls, Iowa 50613 

800.626-4081, E-mail: sales@aldpub.com 

Texas Nurses Association 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 Texas Nurses Association 

(TNA) 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. TNA 

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 the views of 

the staff, board, or membership of TNA or those of the 

national or local associations. 

Copyright © 2013 by Texas Nurses Association, 

a constituent member of the 

American Nurses Association.

April, May, June 2013 Texas Nursing Voice • Page 3 

Violence Against Nurses 

Nurses from Collaborating Groups Testify for HB 705 

by Ellarene Duis Sanders, PhD, RN, NEA-BC 

House Bill 705 is authored by Rep. Donna 

Howard (D-Austin), who is also a registered 

nurse. The bill promotes reducing violence 

against emergency room (ER) nurses and other 

ER personnel through enhanced penalties for 

assaults. The bill was heard April 2, 2013 in the 

House Committee on Criminal Jurisprudence. 

The hearing on this bill began with Rep. 

Howard explaining the bill intent for the 

committee. She emphasized that in the course 

of doing their work in the ER, nurses are often 

verbally or physically assaulted by patients 

and their family members. Currently, if police 

officers, emergency medical services (EMS) 

workers, firefighters, and other public servants 

are assaulted, the perpetrator receives higherlevel 

criminal charges than when nurses are 

assaulted. HB 705 would add nurses and 

emergency room personnel to that list so that 

the charges and penalties would be the same 

for everyone. The enhanced penalties would 

not apply in the event that the patient has a 

mental illness and the assault occurs as a result 

of the illness or if the emergency room nurses 

and personnel have not been trained in deescalation 

techniques. 

A total of nine people testified in favor of 

HB 705; three testified against, two spoke on 

the bill, and one resource witness appeared. 

These witnesses provided more than two hours 

of testimony and responded to a number of 

questions asked by committee members. 

Testimony 1 

The first witness was Mary LeBlond, MSN, 

RN, CEN, CA-SANE, CP-SANE of the Texas 

Emergency Nurses Association (ENA). During 

her introduction, she noted that there are more 

than 3500 members of her association. She is 

employed as an emergency nurse. LeBlond 

identified four key outcomes of passing the bill: 

• Send a message to the public that violence 

against caregivers will not be tolerated; 

• Enable those working in health care to deescalate 

situations by informing aggressors 

that further action may result in felony 

prosecution; 

• Encourage individuals to report these events 

with the knowledge that it will receive 

appropriate review; and 

• Provide prosecutors with an additional tool 

in plea bargaining these events. 

In addition, LeBlond shared startling statistics 

about the incidence of violence against nurses 

in recent years. A survey of ENA members 

conducted in 2006, 2010 and 2011 found that 

86 percent of respondents reported being 

a victim of violence during the preceding 

three years, with 20 percent reporting that 

workplace violence is a frequent occurrence. 

The perpetrators of the violence were equally 

divided between patients, family members, and 

visitors. Verbal abuse has been reported by up 

to 100 percent of nurses in some emergency 

rooms. 1 

LeBlond emphasized that what the Texas 

Emergency Nurses Association is asking for by 

supporting the bill is, “equality of protection 

already shared by other public service 

professions. Nothing more and really nothing 

less.” 

Testimony 2 

Norma Broadhurst of Corpus Christi testified 

as a victim of assault. She is a registered 

nurse who had worked in emergency rooms 

for a number of years prior to her assault. 

During Spring Break of 2011, an intoxicated 

and disruptive patient bit off her right ring 

finger. She has not been able to work since 

the incident. She pressed charges against the 

patient and reported the incident within her 

facility but to her knowledge, the patient spent 

only a couple of days in jail and the charges 

have not been pursued. 

Testimony 3 

Sally Gillam, RN, member of the Texas Nurses 

Association and the Texas Organization of 

Nurse Executives, is the chief nursing officer at 

St. David’s South Austin Medical Center. She 

has been employed there for 25 years. That St. 

David’s emergency department cares for over 

100,000 patients each year. Gillam shared some 

additional statistics: 

• Nurses working in the emergency 

department are the most likely of all health 

care providers to be assaulted; 

• Nurses account for four percent of 

workplace violence in the United States. 2 

• Nurses are injured more frequently by 

violent events than any other role in health 

care settings. 3 

Gillam testified that nurses and nursing 

staff who work in emergency departments are 

typically educated on de-escalation techniques 

but have limited self-defense training compared 

to police and other public servants. She 

responded to several questions from committee 

members including one about why hospitals 

don’t do more to protect their staff. Gillam 

emphasized that hospitals do have many 

strategies in place to improve workplace safety 

but that violence is very unpredictable so even 

to add security staff, as an example, may not 

prevent violence unless the security staff is right 

next to the patient/family/visitor as they explode 

into a violent act. 

Testimony 4 

Jeff Scott, an emergency medical technician, 

spoke for the bill. He reported that while some 

patients are mentally ill or intoxicated, “some 

people are just mean.” Scott said that it isn’t 

right that first responders in the field have more 

protection than nurses in the emergency room. 

Testimony 5 

Elizabeth Sjoberg, JD, RN of the Texas 

Hospital Association (THA) testified for the bill. 

According to Sjoberg, the bill would address 

Violence Against Nurses continued on page 14 

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Follow the Status of 

Priority Bills for Nursing 

While the Texas Legislature is in session, 

Texas Nurses Association provides for daily tracking 

of the bills important to nursing. 

At texasnurses.org, 

TNA invites you to follow the 

status of Priority Bills for Nursing. ★ 

Federal Correctional 

Institution in 

Fort Worth, Texas is 

seeking 

RNs, LVNs, CNAs & 

EMT/Paramedics. 

We offer competitive salaries including extra 

pay for working nights, Sundays, and federal 

holidays. 

Great law enforcement retirement benefits 

including Health/Life insurances, TSP, and a 

possible recruitment bonus. 

If interested call Janie Kirvin, DON 

817-413-3423 or e-mail 

FTW/Recruiter@bop.gov EOE 

During National 

Nurses’ Week, 

we’d like to 

thank all our 

nurses for the 

wonderful care 

they give our 

children. 

CNE Workshops, 

2013 

Texas Nurses Association’s spring 2013 

continuing nursing education (CNE) calendar 

of Individual Activity workshops and Approved 

Provider workshops has been finalized and is 

listed below. Get all the details and register at 

texasnurses.org > CNE Calendar. 

Individual Activity Workshops 

Tuesday, May 7 

Wednesday, May 29 

Thursday, June 13 

Friday, June 28 

Approved Provider Workshops 

Friday, May 17 

Thursday, May 23 

Wednesday, June 5 

Tuesday, June 18 

Tuesday, July 2 

Texas Nurses Association/Foundation Provider 

Unit is accredited as a provider of continuing nursing 

education by the American Nurses Credentialing 

Center’s Commission on Accreditation. ★ 

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Apply Online Today www.careersatdads.com 

Texas Department of Aging and Disability Services 

Health Consequences for Texas: continued from page 1 

Reduced access to highly effective 

contraceptives increases unplanned 

pregnancies, which increases the number 

of: 

• Pregnant women receiving late or no 

prenatal care 

• Birth defects, due to fewer women taking 

folic acid early in pregnancy and fewer 

women controlling their diabetes before 

pregnancy 

• Fetal exposure to tobacco, alcohol, drugs, 

and medications 

• Premature and low birth weight babies, 

with increased risk of infant mortality, 

lifelong health problems, and high medical 

costs 

• Children with poor physical and/or mental 

health 

• Women and men unable to complete their 

education 

• Families unable to rise out of poverty 

• Babies born to unmarried women 

Resources 

Ananat, E., & Hungerman, D. (2007). The power of the pill 

for the next generation. National Bureau of Economic Research 

Working Paper 13402. 

Bloom, D., & Greenhill, R. (2012, July 10). Invest in Family 

Planning, Escape Poverty. Retrieved August 26, 2012, from Bill 

and Melinda Gates Foundation, Impatient Optimists: http:// 

www.impatientoptimists.org/Posts/2012/07/Invest-in-Family- 

Planning-Escape-Poverty 

Conde-Agudelo, A., Rosas-Bermudez, A., & Kafury-Goeta, 

A. (2006). Birthspacing and risk of adverse perinatal outcomes: 

A metanalysis. JAMA, 295 (15), 1809-1823. 

Gipson, J., Koenig, M., & Hindin, M. (2008). The effects of 

unintended pregnancy on infant, child, and parental health: A 

review of the literature. Studies in Family Planning, 39 (1), 18- 

38. 

Guttmacher Institute. (2012, May). Facts on Publicly 

Funded Contraceptive Services in the United States. Retrieved 

August 26, 2012, from http://www.guttmacher.org/pubs/fb_ 

contraceptive_serv.html#14 

Piepert, J., & al, e. (2012). Preventing unintended 

pregnancies by providing no-cost contraception. Obstetrics & 

Gynecology , 120 (6), 1291-1297. 

Texas Department of State Health Services. Fiscal Year 2012 

Operating Budget. 

Texas Health and Human Services Commission. (n.d.). 

Women’s Health Program Enrollment as of August 2011. 

Retrieved December 15, 2012, from http://www.hhsc.state. 

tx.us/research/wh-final-count.asp 

Texas Health and Human Services Commission. (2011). 

State of Texas. 1115 Research and Demonstration Waiver 

Renewal Application. 

Texas Women’s Healthcare Coalition. (2013). Texas 

Women’s Healthcare in Crisis. San Antonio: MHM. 

The National Campaign to Prevent Teen and Unplanned 

Pregnancy. (2008, May). Fast Facts. Retrieved January 12, 2013, 

from http://www.thenationalcampaign.org/resources/pdf/fastfacts-consequences-of-unplanned-pregnancy.pdf 

Zhu, B. (2005). Effects of interpregnancy interval on birth 

outcomes: Findings from three recent US studies. International 

Journal of Gynecology and Obstetrics, 89 (Supplement 1), 

S25-S33. 

About the Author: Stacey Cropley, DNP, RN, CPN, is 

director of practice, Texas Nurses Association. ★ 

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FREE Webinars for Nursing Faculty On 

Teaching in a Concept-Based Curriculum 

Compliments of Texas Team Action Coalition’s 

Academic Progression in Nursing Education Grant 

The Texas Team Action Coalition, convened to advance the Future 

of Nursing: Campaign for Action, received an Academic Progression in 

Nursing Education (APIN) grant in 2012 from the Robert Wood Johnson 

Foundation. With the two-year grant funding, Texas Team intends to build 

for Texas a more highly educated, diverse nursing workforce by increasing 

the number of ADN-prepared RNs who return to school for a BSN degree. 

Streamlining education by developing a concept-based curriculum that 

both associate degree nursing programs and baccalaureate programs across 

Texas can adopt is a key strategy of the APIN grant. It is believed it would 

allow nurses to more easily and seamless transition to higher levels of 

education. 

Free Webinars 

Implementing a concept-based curriculum requires a change in 

perspective and teaching-learning strategies. As part of the APIN grant, 

Academic Consulting Group: A Service of Elsevier will be providing free 

webinars to Texas nursing faculty to implement the grant’s concept-based 

curriculum. 

Upcoming Webinars 

• April 17 – Integrating Concept-Based Curricula into Class, 

Laboratory and Clinical Experience, 2-4 p.m. CDT, Speaker: Kristin 

Oneail, MSN, RN, assistant professor, Lourdes University School of 

Nursing 

• June 12 – Evaluation in a Concept-Based Curriculum, 2-4 p.m. CDT, 

Speaker: Linda Miles, EdD, RN, chair, School of Nursing, Daytona 

State College 

• August 14 (tentative date) – Helping Preceptors Work With Students 

in a CBC Curriculum 

Previously Recorded Webinars (access at texasapin.org) 

• Implementing Concept-Based Curriculum: A Practical Approach, 

presented by Dr. Nelda Godfrey, associate dean, University of Kansas 

Medical Center School of Nursing. ★ 

HAVE YOU REGISTERED YET 

FOR THE APRIL 25 HIT 

CNE WEBINAR? 

The date is fast approaching for the last-in-the-Spring 2013-series of 

FREE, Health Information Technology CNE Webinars, provided by 

Texas Nurses Association and Texas Organization of Nurse Executives. 

April 25 – Optimizing Communication 

with Information Technology: Creating the 

Environment Conducive to True Progress, 

presented by Mary Beth Mitchell, MSN, RN, BC and 

Donna Montgomery, BSN, MBA, RN-BC. 

12 noon to 1 p.m. CDT (webinar access begins at 

11:45 a.m.) 

You’ll learn about: 

• strategies for communicating the needs 

of a clinician to IT development teams, 

• common barriers to good communication 

between nursing and IT, 

• ways to measure and evaluate the 

success of a project through ongoing 

communication. 

1.0 contact hours will be awarded 

for successful completion. 

Still FREE to pre-registrants. 

FIND DETAILED INFORMATION and REGISTER 

at texasnurses.org 

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Nursing Practice Act 

Amendments 

Besides the workplace advocacy issues 

being addressed this 83rd Legislative Session, 

nursing is addressing several needed changes 

to the Texas Nursing Practice Act that have been 

identified. The changes will be addressed in 

SB 1058 by Sen. Nelson and companion bill HB 

2358 by Rep. King. 

Deferred Disciplinary Action – makes 

permanent the Texas Board of Nursing’s 

pilot authority to take deferred disciplinary 

actions. The pilot permits the BON to delay 

final disciplinary action for a relatively minor 

violation, place the nurse on probation and 

dismiss the action if probation is successfully 

completed. The BON’s authority to conduct the 

pilot will end after this legislative session if the 

Nursing Practice Act is not amended. 

Student Criminal Background Checks – 

would make criminal background checks 

mandatory for students at the time they are 

accepted for enrollment rather than at the time 

of licensure. 

Confidentiality of TPAPN Orders – would 

make confidential BON orders sending a nurse 

to participate in the Texas Peer Assistance 

Program for Nurses to address a problem with 

chemical dependency or mental illness. Board 

orders are currently public record and normally 

include details about the problem. ★ 

Member, Texas Tech University System 

Position announcement 

PROGRAM DIRECTOR FOR NURSING/ 

BUDDY DAVIDSON ENDOWED CHAIR 

Angelo State University is seeking a Nursing Program Director to 

join the Physical Therapy and Athletic Training Program Directors 

in the Department of Nursing and Rehabilitation Sciences with an 

anticipated start date of Fall 2013. 

Qualifications 

Earned doctorate from a regionally accredited institution and a 

Master of Science in Nursing. 

Current unrestricted RN license in the state of Texas (or eligible) 

Nursing Legislative 

Agenda Coalition 

During a legislative session, Texas Nurses 

Association serves as the host organization 

for the Nursing Legislative Agenda Coalition. 

The coalition consists of nursing organizations 

that endorse and work to enact the Nursing 

Legislative Agenda. Coalition members are: 

Texas Nurses Association 

Licensed Vocational Nurses Association of Texas 

Association of periOperative Registered Nurses 

– Houston 

Association of Women’s Health, Obstetrics & 

Neonatal Nurses 

Coalition for Nurses in Advanced Practice 

Consortium of Texas Certified Nurse Midwives 

Houston Oncology Nurses Association 

Houston Organization of Nurse Executives 

Society of Otorhinolaryngology & Head & Neck 

Nurses – Houston 

Texas Association of Deans & Directors of 

Professional Nursing Programs 

Texas Association of Nurse Anesthetists 

Texas Clinical Nurse Specialists 

Texas Council of periOperative Registered 

Nurses 

Texas Emergency Nurses Association 

Texas Nurse Practitioners 

Texas Nursing Students’ Association 

Texas Organization for Associate Degree 

Nursing 

Texas Organization of Baccalaureate & Graduate 

Nurse Educators 

Texas Organization of Nurse Executives 

Texas RN First Assistants Network 

Texas School Nurses Organization ★ 

SB 406/HB 1055: 

APRN Prescriptive 

Authority Legislation 

In this 83rd Texas Legislative Session, a longsought 

agreement between nursing, medicine, 

physician assistants and lawmakers was reached 

and resulted in the filing in early February 

of legislation that will expand prescriptive 

authority for advanced practice registered 

nurses (APRN). A joint press conference held at 

the Capitol on February 6 by Sen. Jane Nelson 

(R-Flower Mound), chairwoman of the Senate 

Health and Human Services Committee, and 

Rep. Lois Kolkhorst (R-Brenham), chairwoman 

of the House Public Health Committee, 

announced the agreed-to legislation – Senate 

Bill 406/House Bill 1055. 

SB 406 will continue a delegated model for 

APRNs but will eliminate site-based, physician 

supervision requirements that have created 

barriers to practice. The site-based model will 

be replaced by a signed prescriptive authority 

agreement through which physicians will 

delegate authority to prescribe and order a 

drug or device to an APRN or physician assistant 

(PA). SB 406 increases from four to seven the 

number of APRNs and PAs that a physician 

may delegate prescriptive authority; improves 

communication and coordination between the 

Texas Medical Board, the Board of Nursing, and 

Physician Assistant Board; and allows physicians 

to delegate prescriptive authority for Schedule 

II controlled substances to APRNs and PAs in 

hospitals and hospice settings. ★ 

HB 2361/SB 1375: 

Self-Directed, 

Semi-Independent 

Status of Certain 

Health Care Regulatory 

Agencies 

To view and apply visit www.angelo.edu 

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If granted self-directed, semi-independent 

status by the Texas Legislature, the Texas Board 

of Nursing would gain more flexibility in making 

budget outside of the current appropriations 

process which sets two years in advance the 

budgets and numbers of FTE employees that 

can be hired. The two-year budget cycle makes 

effective response to changing constituent 

needs very difficult. 

HB 2361 authored by Rep. Drew Darby 

(R-San Angelo) would grant SDSI status to the 

Texas Board of Nursing, Texas State Board of 

Pharmacy, and Texas Medical Board. The three 

agencies undergo Sunset Review in 2017 so 

the Legislature could evaluate the application 

of SDSI to health care licensing agencies since 

currently, none of the nine agencies with the 

status are health care professional licensing 

agencies. 

SDSI status would allow the BON, TSBP and 

TMB to set their budgets on an annual basis, 

operate more like a business with flexibility 

to manage resources as needed and enhance 

responsiveness to licensees and the public. ★


Nursing’s Workplace Advocacy Legislative Agenda 

by Stacey Cropley, DNP, RN, CPN 

Prior to each legislative session, the Texas 

Nurses Association hosts a series of meetings 

for nursing organizations in Texas to identify 

and develop a consensus on significant nursing 

and health care-related issues that need to be 

addressed by the Texas Legislature. Identified 

issues can emphasize nursing, public health or 

public health policy that is determined harmful 

either to nursing or the public. This consensus 

of nursing opinion becomes the Nursing 

Legislative Agenda for the session. See page 6 

for member organizations. 

The Texas Nurses Association has historically 

articulated a strong voice for workplace 

advocacy, supported by legislation that has 

improved the nursing workplace environment 

economic and general welfare of Texas nurses 

in a variety of nursing roles. The information 

below will highlight the workplace advocacy 

issues being addressed this biennium through 

the 2013 Nursing Legislative Agenda. 

HOUSE BILL 581: Provides nurses in public 

hospitals a limited remedy to recover damages 

caused by illegal retaliation for engaging in 

protected patient advocacy activities. 

The assertion of sovereign immunity against a 

nurse employed by a public hospital who seeks 

a remedy in court for illegal retaliation is not 

new. In fact, in 1999, the Court of Appeals for 

the First District of Texas found that the Texas 

Nursing Practice Act did not provide a waiver 

of sovereign immunity [The University of Texas 

Medical Branch at Galveston, 6 S.W.3d 767 

(1999)]. 

Currently, a public hospital-employed nurse 

may file suit only if illegally retaliated against for 

making an external report to a law enforcement 

or regulatory agency. The nurse cannot file suit 

if retaliated against for making the same report 

internally or to an accrediting body. Conversely, 

a private hospital-employed nurse may seek 

recovery for illegal retaliation in both instances. 

These deficiencies are highlighted by the 

well-publicized cases of the two Winkler 

County nurses who were retaliated against 

for reporting a physician to the Texas Medical 

Board for unsafe patient care. The report 

made was the culmination of nearly a year of 

expressed concern by the nurses to the medical 

staff, the hospital administrator, and the hospital 

internal reporting processes. 

These nurses were terminated and criminally 

indicted for making a report to the Medical 

Board. Charges against one were dismissed. The 

other nurse was found not guilty by a jury. The 

two nurses then filed a civil lawsuit in federal 

court based on retaliation under state law and 

violation of their civil rights under federal law. 

Because the nurses were employed by a county 

hospital, the claim for relief for the retaliation 

under the Nursing Practice Act was dropped as 

a defense of sovereign immunity was asserted. 

However, the nurses were able to state a claim 

under the Public Employees Whistleblower Law 

because they had also reported externally to 

the Texas Medical Board. If the nurses had not 

made an external report, they would not have 

been afforded these limited protections under 

state law. 

HB 581 by Rep. Donna Howard (D-Austin) 

addresses this deficiency in patient advocacy 

protections for nurses. It gives nurses 

employed by public hospitals the same right 

as their colleagues in private hospitals to 

recover damages suffered because of illegal 

retaliation for making a protected report, 

whether reported internally or externally. 

The bill amends the Nursing Practice Act to 

permit nurses employed by public hospitals to 

recover damages caused by illegal retaliation 

for engaging in protected patient advocacy 

activities. 

The type and amount of recovery would 

be subject to the limits imposed by the Texas 

Public Employee Whistleblower Law which 

prohibits punitive damages and caps future 

earnings and nonpecuniary damages based 

on the size of the governmental entity as 

determined by the number of its employees. 

The limited waiver of sovereign immunity for 

state and local entities only affects the right to 

file a lawsuit for harm suffered when subjected 

to illegal retaliation and does not extend to 

nurses employed by other governmental 

entities. The bill is specific to public hospitals. 

As of April, action is pending in the House 

Judiciary and Civil Jurisprudence Committee. 

There is no companion bill at this time. 

HOUSE BILL 705: Reduces Violence Against 

Nurses in the Workplace by Enhancing 

Penalties for Assault of ER Personnel 

Workplace violence is defined by the 

National Institute for Safety and Health (2002) 

as acts of violence committed against those 

at work or on duty. Workplace violence is 

common in health care settings, with health 

care ranked among the most dangerous 

occupations in regard to risk of workplace 

assault. 

And workplace violence is on the rise. In 

any given week, 8-13 percent of emergency 

department nurses are the victims of physical 

assault while at work. Current law gives explicit 

protection and enhanced penalties for assault 

to public servants or police officers, security 

officers, emergency services personnel, and 

several other protected classes – excluding 

nurses. Health care providers in Texas are 

provided no additional legal protections against 

workplace violence while engaging in this high 

risk occupation. Being assaulted should not be 

part of a nurse’s job. 

HB 705 by Rep. Donna Howard (D-Austin), 

makes assault against emergency room 

personnel a third-degree felony for all nonpatients 

and for patients if the emergency 

• Designed specifically for the 

Licensed Practical/Vocational 

Nurse 

• No on-campus classes to attend! 

• Clinical Component May Be 

Completed Where You Live 

• Graduate from a Highly 

Acclaimed, Fully Accredited 

Program 

More information can be obtained by visiting 

www.allegany.edu/onlineLPN-RN 

room personnel has not received training in 

de-escalation and crisis intervention techniques 

to facilitate interaction with patients, including 

patients with mental illness or intellectual 

disabilities, that meets the minimum standards 

established by the Department of State Health 

Services. 

This bill has been referred to the Criminal 

Jurisprudence Committee and action is 

pending. No Senate companion bill has been 

filed at this time. See related story page 3. 

SENATE BILL 418: Assures Parents Know if a 

School Nurse is Assigned to Child’s School 

Children with special health care needs 

are on the rise and it has never been more 

important for parents to know whether a 

school has a nurse to care for these children. 

Currently, schools are not obligated to inform 

parents if their child’s school has a full-time 

nurse assigned. Parents have a right to know 

when a full-time nurse is not assigned to their 

child’s school so they may take steps to ensure 

their child’s health care needs are met while at 

school. 

These steps may include giving specific 

instructions to the teacher on how to respond 

to any special health condition their child 

may have, instructing the school to call them 

immediately if something happens, and making 

special arrangements at work to be able to 

respond. Parents may not take these additional 

steps if they believe a full-time nurse is present 

on the school campus. 

SB 418 by Sen. Rodney Ellis (D-Houston) 

requires public schools or open-enrollment 

charter schools to notify parents if a nurse is not 

assigned to the campus during all instructional 

hours. The bill mandates nothing more than 

notification and full disclosure to the parents. 

This bill was referred to the Education 

Committee for consideration. 

About the Author: Stacey Cropley, DNP, RN, CPN is 

director of practice, Texas Nurses Association. ★ 

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by Carol Cannon, BSN, RN, OCN 

Cancer Control 

April is Cancer Control Month. As outlined 

by the World Health Organization, cancer 

control involves addressing each step along the 

cancer continuum: prevention, early screening/ 

detection, diagnosis/treatment, and palliative 

care/survivorship. 1 

Nurses play major roles in each of these 

phases but perhaps the areas where nurses are 

most effective in reducing the cancer incidence 

are prevention and early screening/detection, 

or primary and secondary prevention. 

While providing everyday care, nurses are 

able to interact with patients, form trusting 

relationships, and educate and empower 

patients to address cancer-causing habits early 

before the disease ever occurs. 

While some cancers are genetic and not due 

to modifiable behaviors, the American Cancer 

Society states that a substantial proportion 

of cancers can be prevented. These include 

all cancers caused by cigarette smoke and 

heavy alcohol consumption, overweight or 

obesity, poor nutrition, as well as cancers due 

to infections: human papillomavirus (HPV), 

hepatitis B virus (HBV), hepatitis C virus (HCV), 

human immunodeficiency virus (HIV), and 

Helicobacter pylori (H. pylori). 2 This long list 

of modifiable risk factors represents a gap in 

patient knowledge that can be closed with 

education from the nurse. 

Screening offers an additional defense 

against cancer. The National Comprehensive 

Cancer Network currently recommends 

screening for breast, cervical and colorectal 

cancers; it also recently added lung 

cancer screening guidelines to its list of 

recommendations. 3 

According to the Texas Cancer Registry, 

cancer is the leading cause of death for Texans 

aged 85 years and younger. It is the leading 

cause of death from disease among Texas 

children aged 1 to 14 years. In 2012, it was 

estimated that 110,135 Texans would be newly 

diagnosed with cancer and 39,072 will die of 

the disease. Additionally, the estimated cost of 

cancer in Texas for 2010 is $25.3 billion. 4 

These statistics bring to light Texas’ desperate 

need to more effectively control cancer and its 

human and economic burden. Fortunately, the 

Cancer Prevention Research Institute of Texas 

(CPRIT) plays a key role in cancer prevention 

in the State of Texas. Ten percent of the total 

amount of money CPRIT awards each year 

is specifically devoted to delivering cancer 

prevention programs and services in Texas. 

WE DEFEND NURSES! 

(throughout the State of Texas) 

• BON Defense • Peer Review Assistance 

• TPAPN Assistance • RN and LVN Reinstatements 

Are you under investigation or received 

a complaint letter? 

Call our law firm NOW! 

Austin: (512) 476-5757 

Houston: (713) 225-7474 

San Antonio: (210) 223-5553 

BERTOLINO LLP 

www.belolaw.com 

Nurse Oncology Education Program 

The Nurse Oncology Education Program 

(NOEP), which receives funding from 

CPRIT’s prevention category, is a nonprofit 

project of the Texas Nurses Association/ 

Foundation. The long-term vision of NOEP is 

to reduce the burden of cancer in Texas and 

beyond by providing education to nurses in 

cancer prevention, detection, treatment and 

survivorship. Thanks to CPRIT funding, NOEP 

is creating and launching two free continuing 

nursing education modules on its website, 

noep.org. The modules are titled, Nursewise: 

Nutrition & Physical Activity and Tobacco 

Cessation: What the Nurse Needs to Know. 

Nurses across Texas and nationwide are in 

positions to effectively reach vulnerable 

populations. 

Nurses bring so many dimensions to the 

table: knowledge of the pathophysiology of 

cancers, ability to navigate the complex systems 

of health care and insurance, compassion 

for newly diagnosed patients and long-term 

survivors, just to name a few. NOEP offers 

oncology education to all nurses, because 

every nurse should know the risk factors and 

screening recommendations, no matter his 

or her field of practice. It is the hope at NOEP 

that in educating nurses, we are empowering 

patients, and ultimately reducing cancer 

incidence, morbidity and mortality. 

Texas A&M AgriLife Extension 

The Texas A&M AgriLife Extension, a prime 

example of secondary prevention and another 

CPRIT prevention grantee, involves a largely 

collaborative effort between local nurses 

and other health care providers, clinics and 

hospitals, The University of Texas at Austin 

School of Social Work faculty, and the expert 

AgriLife Extension network to increase access to 

cancer prevention services. Dr. Carol Rice, RN 

leads the enormously successful screening and 

diagnostic service project which targets women 

living in frontier, rural and border areas of Texas, 

who are less likely than their urban counterparts 

to have had a mammogram or Papanicolau (Pap) 

test within the past two years. 

Dr. Rice’s project has become so successful 

that enrollment for its events is often capped 

due to lack of sufficient meeting space. And if 

the participation in the project is not enough 

to validate its success, the positive outcomes 

certainly do. Dr. Rice recalls that earlier this 

winter, a participant utilized the project to have 

a routine check-up and an abnormal finding 

was discovered. With the funding from CPRIT, 

the Extension project was able to pay for a 

diagnostic follow up, as the woman did not 

have health insurance. She was diagnosed with 

cervical cancer and was scheduled for surgery 

almost immediately at a discounted rate with a 

payment plan for the physician and the hospital, 

all coordinated through the project. Dr. Rice 

attributes the success of the program largely to 

the Extension Network, which boasts 251 offices 

in 254 counties in Texas, as well as experts on 

the ground who have relationships with the 

regional patient populations and health care 

providers. Dr. Rice looks forward to making 

the initiative statewide in the future, because 

Extension is a statewide network. 

Previously, Dr. Carol Rice was awarded a 

fellowship from the Nurse Oncology Education 

Program to study at MD Anderson Cancer 

Center. From that experience, she was able to 

gain tools and skills that would later be crucial 

in her ability to operate a large project such as 

the Texas A&M AgriLife Extension screening 

and early detection program funded by CPRIT. 

Fortunately for Texans, cancer control is a goal 

shared by educational institutions, nonprofits, 

and other agencies across the state. Because 

of this, partnerships, collaborations or other 

relationships among these groups—like the one 

between NOEP and Dr. Rice—are common and 

beneficial to the people of Texas. Nurses play a 

paramount role to lead the state in controlling 

cancer through primary and secondary 

prevention, but collaboration of nurses with 

other stakeholders is what will ensure a 

successful attempt in the cancer control battle. ★ 

References 

1. World Health Organization. (2013). Cancer Control: 

knowledge into action. Retrieved from http://www.who.int/ 

cancer/modules/en/ 

2. American Cancer Society, Inc. (2013). Cancer Facts and 

Figures.Retrieved from http://www.cancer.org/acs/groups/ 

content/@epidemiologysurveilance/documents/document/ 

acspc-036845.pdf 

3. National Comprehensive Cancer Network. (2013). 

NCCN Guidelines for Detection, Prevention and Risk 

Reduction. Retrieved from http://www.nccn.org/professionals/ 

physician_gls/f_guidelines.asp#detection 

4. Texas Cancer Registry: Texas Department of State Health 

Services, National Program of Cancer Registries-Centers for 

Disease Control and Prevention, and Cancer Prevention and 

Research Institute of Texas.2012 Texas Selected Cancer Facts. 

Retrieved from http://www.dshs.state.tx.us/tcr/statisticalData/ 

Texas-Fact-Sheets-2012.aspx 

About the Author: Carol Cannon is an Oncology Certified 

Nurse who is new to Austin, Texas. She worked previously as a 

clinical research nurse on the Oncology/Hematology/Stem Cell 

Transplant Unit at the National Institutes of Health in Bethesda, 

Md. She began her nursing career in the cardiac ICU, and feels 

she has found her passion since working in oncology. 

AT THE CROSSROADS: 

Cancer in Ages 15-39 

Watch this award-winning short video 

series at noep.org and earn 

1.0 contact hours of free CNE. 

A nonprofit project of the Texas 

Nurses Association/Foundation 

Watch at noep.org 

Texas Nurses Association/Foundation Provider Unit is 

accredited as a provider of continuing nursing education 

by the American Nurses Credentialing Center’s Commission 

on Accreditation. 

The Nurse Oncology Education Program (NOEP) is part of 

Texas Nurses Association/Foundation Provider Unit. 

This initiative was supported by Cooperative Agreement 

Number u55/DP624967 from the Centers for Disease 

Control and Prevention. Its contents, findings, and 

conclusions are those of the author(s) and do not 

necessarily represent the official position of the Centers for 

Disease Control and Prevention.


Colorectal Cancer Screening Methods at a Glance 

by Joni Watson, MBA, MSN, RN, OCN® 

While colorectal cancer (CRC) deaths have 

declined slowly over the last 20 years, deaths 

from CRC still make up close to nine percent 

of all cancer deaths, making it the third most 

prevalent cancer among both men and women 

(American Cancer Society [ACS], 2013a; Centers 

for Disease Control and Prevention [CDC], 

2012). According to the American Cancer 

Society and the U.S. Preventive Services 

Task Force (USPSTF), both men and women 

at average risk for colorectal cancer should 

begin routine screening at age 50 (ACS, 2013b; 

USPSTF, 2008). 

With a wide variety of CRC screening tests 

and procedures available today, which one 

should patients choose? Screening proponents 

argue, “The best CRC screening test is the 

one that gets done.” Nurses should speak 

with patients and their families about the 

recommended, evidence-based screening 

guidelines, follow-up test(s) that may be 

needed if screenings come back with positive 

or suspicious findings, and any attitudes or 

beliefs that may lead to non-adherence to 

recommended screening guidelines. In order 

to be effective, nurses in all fields of practice 

must remain current on evidence-based CRC 

screening guidelines. 

The American Cancer Society divides 

CRC screening tests into two categories: (1) 

those that primarily find colorectal polyps 

and cancer and (2) those that primarily find 

colorectal cancer (ACS, 2013). Colonoscopy – 

the gold standard of CRC screening, flexible 

sigmoidoscopy, double-contrast barium enema, 

and CT colonography/virtual colonoscopy can 

find CRC as well as polyps, which are often 

precursors to CRC. 

The first three tests are invasive, while virtual 

colonoscopy utilizes noninvasive imaging. 

The fecal occult blood test (FOBT) and fecal 

immunochemical test (FIT) are also noninvasive 

tests that involve stool sampling. Stool DNA 

testing, or sDNA, was formerly included in 

Test Pros Cons 

Colonoscopy Done every 10 years. Can miss small polyps. 

Can usually view entire colon. Full bowel preparation needed. 

Can biopsy and remove polyps. More expensive on a one-time basis 

Can diagnose other diseases. than other forms of testing. 

Sedation of some kind is usually 

needed. 

Will need someone to drive you home. 

You may miss a day of work. 

Small risk of bleeding, bowel tears, or 

infection. 

Flexible Done every 5 years. Views only about one-third of the colon 

sigmoidoscopy Fairly quick and safe. Can miss small polyps. 

Usually doesn’t require full bowel Can’t remove all polyps. 

preparation. 

Very small risk of bleeding, infection, 

Sedation usually not used. 

Does not require a specialist. 

or bowel tear. 

Colonoscopy will be needed if 

abnormal. 

Double-contrast Done every 5 years. Can miss small polyps. 

barium enema Can usually view entire colon. Full bowel preparation needed. 

(DCBE) Relatively safe. Some false positive test results. 

No sedation needed. 

Cannot remove polyps during testing. 


abnormal. 

CT colonography Done every 5 years. Can miss small polyps. 

(virtual Fairly quick and safe. Full bowel preparation needed. 

colonoscopy) Can usually view entire colon. Some false positive test results. 

No sedation needed. 

Cannot remove polyps during testing. 


abnormal. 

Still fairly new - may be insurance 

issues. 

Fecal occult No direct risk to the colon. Should be done every year. 

blood test (FOBT) No bowel preparation. May miss many polyps and some 

Sampling done at home. 

cancers. 

Inexpensive. 

May produce false-positive test results. 

May have pre-test dietary limitations. 


abnormal. 

Fecal No direct risk to the colon. Should be done every year 

immunochemical No bowel preparation. May miss many polyps and some 

test (FIT) No pre-test dietary restrictions. cancers. 

Sampling done at home. 

Fairly inexpensive. 

Source (Adapted): American Cancer Society, 2013b 

May produce false-positive test results. 


abnormal. 

recommended CRC screening guidelines, but 

testing intervals were uncertain and now this 

testing is no longer available within the United 

States (ACS, 2013). Each test has benefits and 

risks, pros and cons. Nurses can educate 

patients and families about the various CRC 

screening methods, providing support and 

encouragement for patients’ evidence-based 

screening choices. 

Learn more about colorectal cancer and 

the ways you can make a difference with free 

Continuing Nursing Education at www.noep. 

org. ★ 

References 

American Cancer Society. (2013a). Cancer Facts and 

Figures 2013. Atlanta, GA: American Cancer Society. 

American Cancer Society. (2013b). Colorectal Cancer Early 

Detection. Retrieved February 3, 2013, from http://www. 

cancer.org/cancer/colonandrectumcancer/moreinformation/ 

colonandrectumcancerearlydetection/colorectal-cancer-earlydetection-screening-tests-used 

Centers for Disease Control and Prevention. (2012). 

Prevalence of Colorectal Cancer Screening Among Adults — 

Behavioral Risk Factor Surveillance System, United States, 

2010. Morbidity and Mortality Weekly Report, 61(2), 51-56. 

Retrieved February 3, 2013, from http://www.cdc.gov/mmwr/ 

preview/mmwrhtml/su6102a9.htm 

United States Preventive Services Task Force. (2008). 

Screening for Colorectal Cancer. Retrieved February 3, 2013, 

from http://www.uspreventiveservicestaskforce.org/uspstf/ 

uspscolo.htm 

About the Author: Joni Watson, MSN, RN, OCN is a 

clinical nurse manager at Seton Healthcare Family in Austin, 

Texas, and previously worked as director of the Nurse 

Oncology Education Program. 

Clinical Health 

Facility Surveyor 

The Oklahoma State Department of Health is seeking to fill positions around 

Oklahoma to conduct inspections in nursing facilities, hospitals, surgery 

centers, home care agencies, dialysis centers, and other health care settings. 

Extensive 2-3 day overnight travel required. Extensive training provided. 

Preference given to RNs with valid permanent Oklahoma nursing license. 

Full job descriptions and qualifications are available at: 

http://careers.health.ok.gov/ 

Salary up to $60,000 per year and benefits. 

Send a resume and letter of interest for the clinical 

health facility surveyor position to: E-Mail: surveyors@health.ok.gov 

Fax: Attn: Applications: at (405) 271-4994 

Mail: Office of Human Resources, Oklahoma State Department of Health 

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Photo is provided courtesy of Texas Senate Media Service. 

During Nurse Day at the Capitol, 

February 26, 2013, Senate Resolution 

No. 264 “prepared in honor of the 

nursing profession” by The Senate of 

the State of Texas was read aloud in the 

Senate Chamber by Sen. Jane Nelson 

(R-Flower Mound), chairwoman of the 

Senate Health and Human Services 

Committee. The resolution commended 

all nurses for their “invaluable service to 

this state” and proclaimed the day as 

Nurse Day at the Capitol. Nearly 300 

nurses from across Texas came to Austin 

for the event, presented by Texas Nurses 

Association and the TNA Governmental 

Affairs Committee. Many of the Nurse 

Day participants were present in the 

Senate Gallery which overlooks the 

Senate floor for the reading by Sen. 

Nelson of the special resolution – and 

for the loud cheers that followed. 

Immediately following the reading of the 

resolution, nurses were invited to join 

Sen. Nelson for a commemorative photo 

on the steps outside of the Chamber. In 

the photo, in the middle of the first row, 

Martha Myer, RN of Austin and Sen. 

Jane Nelson proudly share in displaying 

the resolution folder for the camera. 

Safe Nurse Staffing: 

It’s the Law! 

Presented by Texas Nurses Association 

as a one-day, CNE activity or as 

a view-when-you-choose 

webinar series. 

No matter your method of 

participation, this three-part CNE 

series will familiarize the staff nurse 

and nurse leader with the Texas Nurse 

Staffing Law that places staffing requirements 

on hospitals. The three-part series includes an 

introduction to the law, implementation of the 

structure and processes for compliance, and case 

studies that illustrate how staffing problems were resolved with 

critical thinking and an understanding of the law. 

Onsite 3-part Cne aCtivity at tna HeaDQUarters, aUstin: 

June 13 | September 6 | January 22, 2014 

Onsite registration fee is $100 per TNA member; $125 per 

non-TNA member (full day, all three series parts). Lunch and 

workshop materials included. Seating is limited, early registration 

encouraged. 4.5 contact hours will be awarded to participants 

who complete the entire activity. 

Webinar 3-part Cne series: 

Part 1 Part 2 Part 3 

2013 July 8 July 15 July 22 

2013 Oct. 7 Oct 14 Oct. 21 

2014 Feb. 10 Feb. 17 Feb. 24 

Each part in the webinar series awards 1.5 contact hours upon 

successful completion. 

Get full details at texasnurses.org. REGISTER TODAY! 

Texas Nurses Association/Foundation Provider Unit is accredited 

as a provider of continuing nursing education by the American 

Nurses Credentialing Center’s Commission on Accreditation. 

A special resolution “prepared in honor of the nursing profession” and read 

aloud in Senate Chambers by Sen. Jane Nelson welcomed nurses visiting the 

Capitol, commended all nurses for their “invaluable service to this state” and 

proclaimed February 26, 2013 as Nurse Day at the Capitol. ★


Alzheimer’s Disease Partnership: The State of the State Plan 

Involvement in Coalitions 

By partnering in coalitions, Texas Nurses 

Association achieves more for nursing than 

it would by standing alone. Through its 

participation in various coalitions, workgroups 

and state advisory groups, TNA supports 

health policy that improves the health of 

Texans and their access to quality health care, 

and represents the perspective of nursing 

when health care decisions are made in Texas. 

From time to time, TEXAS NURSING 

VOICE reports on the activities and progress 

of various coalitions and workgroups. In this 

issue, guest columnist Laura Lerma, MSN, 

RN, offers three reports on the coalitions and 

workgroups where she represents TNA and 

nursing: Alzheimer’s Disease 2013 Partnership 

Meeting, Texas Health Steps Advisory Panel, 

and Healthy Texas Babies. 

Other groups where TNA represents its 

members and nursing include: 

• Texas Immunization Stakeholder Working 

Group – established by the Texas 

Legislature to improve state immunization 

rates with a focus on children. 

• Texas Public Health Coalition – created in 

2006 to improve the health of Texans by 

advancing core public health principles at 

the state and community levels. 

• Texas HIV/Aids Coalition – founded to 

advocate for HIV/Aids programs funding, 

to expand access to quality care and 

treatment for people living with HIV/Aids, 

and to advocate for public policies that 

promote the health, welfare and civil rights 

of Texans affected by HIV/Aids. 

• Texas Women’s Healthcare Coalition – 

formed to improve the health and well 

being of women, babies and families by 

assuring all Texas women have access to 

preventive care (see page 1). 

On January 30, 2013, the Texas Nurses 

Association (TNA) attended the Alzheimer’s 

Disease 2013 Partnership Meeting – “The State 

of the State Plan.” The Texas state plan was 

developed two years ago under the auspices of 

the Texas Council on Alzheimer’s Disease and 

Related Disorders and the Alzheimer’s Disease 

Program at the Texas Department of State Health 

Services. It addresses four key areas of concern 

related to Alzheimer’s Disease (AD) – Care, 

Disease Management, Prevention, and Science. 

Each key area of concern has an assigned work 

group charged with meeting the goals and 

objectives established by the state plan. The 

partnership meeting was an opportunity for the 

partners and stakeholders to gather for an update. 

The meeting began with a review of the 

Interim Report to the 83rd Texas Legislature of 

the Joint Interim Committee to Study Alzheimer’s 

Disease. The impact of AD on Texas and Texans 

is staggering. AD is defined as a progressive, 

age-related, currently irreversible, terminal 

disease that affects the brain and is manifested 

by problems with memory, thinking and day-today 

functioning. Those impacted by the disease 

demonstrate a decline in cognitive, behavioral 

and physical abilities that often renders 

victims totally dependent upon caregivers. 

The Alzheimer’s Association reports that more 

than 5,000 Texans die annually from AD, that 

approximately 340,000 Texans are currently living 

with the disease with that number expected to 

reach 470,000 by 2025. Currently, there is no cure 

for AD and no proven treatments to prevent its 

development or slow its progression. 

AD also has a significant economic impact. 

The economic impact can be seen in health carerelated 

costs incurred in the care of an individual 

with AD – costs associated with acute care, longterm 

care, and hospice care – and caregiver costs. 

Texas has a variety of programs that support 

AD care and research. These include: 

• Texas Alzheimer’s Disease Program 

• Texas Council on Alzheimer’s Disease and 

Related Diseases 

• Texas Alzheimer’s Research and Care 

Consortium (TARCC) 

• Medicaid Services 

• Medicare Services 

by Laura Lerma, MSN, RN 

• In-Home and Family Support Services 

• Community-Based Agency Services 

• Caregiver Services for Respite and Financial 

Support 

The interim report on Alzheimer’s Disease 

recommends increased AD research funding at 

the state level, the pursuit of additional funding 

sources to support research and implementation 

of the five-year AD state plan, circulation of 

written and online materials that clearly outline 

TARCC’s significant accomplishments, and the 

establishment of a statewide clearinghouse 

for all news stories related to AD research and 

treatment. 

Meeting attendees were privy to presentations 

by Robert Egge of the National Alzheimer’s 

Association and George Vradenburg of US 

Against Alzheimer’s. Mr. Egge brought the 

national perspective to the meeting and statistics 

that are staggering: 

• Five million Americans are currently 

diagnosed with AD. 

• One person every 68 seconds is diagnosed 

with AD. 

• One in three people in the U.S. currently has 

a loved one with AD. 

• AD is the 6th leading cause of death in 

America. 

• In 2012, the economic impact of AD on the 

country was $200 billion. 

• AD with other co-morbid diseases like 

diabetes and coronary heart disease will 

continue to drive health care costs up. 

• It is estimated that by 2050, 16 million 

Americans will be diagnosed with AD. 

The national Alzheimer’s Disease plan that was 

published in 2012 outlines five goals: 

1. Prevention and treatment 

2. Enhancing the quality and efficiency of care 

3. Expanded support to individuals with AD and 

their caregivers 

4. Increased public awareness 

5. Improved data tracking 

It was reinforcing to meeting attendees to see 

how the national plan goals match fairly closely to 

the Texas state plan. 

Mr. Vrandenburg spoke on behalf of US 

Against Alzheimer’s, an Alzheimer’s advocacy 

organization not affiliated with the Alzheimer’s 

Association. US Against Alzheimer’s is a 

collaborative group of philanthropists who are 

“enraged and engaged.” Their purpose is to “fix 

the broken status quo” by encouraging political, 

business and civic leaders to devote the resources 

needed to stop AD by 2020. In order to reach that 

goal, organizations and states – like Texas – need 

to think big and think differently in the areas of 

controlling health care costs, new models for 

funding, and the use of technology. 

A truly eye-opening experience for the 

attendees was the opportunity to hear from 

some of the AD researchers working here in 

Texas. AD research is going on in all corners 

of the state. The areas of research are broad 

based – genetics, biomarkers, amyloid, tau, 

oligomerization, metabolism, lifestyle, infection 

agents, environmental toxins, inflammation, 

oxidative stress, head trauma, and apolupoprotein 

E. In his presentation, George Perry, PhD, dean of 

the College of Sciences, University of Texas at San 

Antonio, stated that there are 30,000 researchers 

currently involved in AD research. 

Time was allotted at the end of the meeting 

for the four, state plan workgroups to meet 

to discuss the progress being made towards 

their identified plan goals and objectives. 

Since the meeting, both the Care Goal Group 

and the Disease Management Goal Group 

have completed one of their goals. Both have 

published guidelines: Understanding Residential 

Care Options for People with Alzheimer’s by the 

Care Goal Group; Clinical Best Practices for Early 

Detection, Diagnosis, and Pharmaceutical and 

Non-Pharmaceutical Treatment of Person with 

Alzheimer’s Disease by the Disease Management 

Goal Group. Both publications are available at – 

dshs.state.tx.us/alzheimers. 

TNA was/is an active member of the Disease 

Management Goal Group and participated in 

the development of the clinical best practices 

document. It is designed for health care 

professionals – physicians, registered nurses, 

advanced practice registered nurses, and 

physician assistants – as a guide and reference 

to assist in the early detection, medical 

management, diagnosis, and pharmacological/ 

non-pharmacological treatment of AD. The 

document also includes a section on Mild 

Cognitive Impairment (MCI). The Disease 

Management Goal Group’s next charge is to 

develop a plan for disseminating the clinical best 

practices to physician practices/clinics, hospitalbased 

practices/clinics, community associations, 

health care provider associations, and rural health 

care providers. 

There is still much to be done. This is an 

exciting time in the fight against Alzheimer’s in 

Texas, as elements of the state plan start coming 

to fruition in an effort to enhance the health 

and well being of all Texans but especially those 

impacted by Alzheimer’s Disease. ★ 

About the Author: Laura Lerma, MSN, RN, 

is CNE program manager for Texas Nurses 

Association and the TNA and nursing’s 

representative to the Alzheimer’s Disease 

Partnership.


Texas Nurses Association and Healthy Texas Babies 


In January 2011, the Texas Nurses Association 

(TNA) was asked to be a member of an expert 

panel (EP) established by the Texas Department 

of State Health Services (DSHS) in partnership 

with the March of Dimes. The Healthy Texas 

Babies (HTB) initiative was launched in an 

effort to develop a comprehensive plan to 

reduce infant mortality in Texas. The EP was 

comprised of a wide range of subject-matter 

experts and stakeholders from across the 

state with the purpose of providing input into 

the development and implementation of a 

coordinated, strategic plan to guide the future 

actions of the HTB initiative. 

The objectives for this inaugural EP meeting 

were: 

1. Outline the public/private partnerships for 

this initiative; 

2. Review the U.S. and Texas data on infant 

mortality and preterm births; 

3. Review the March of Dimes Healthy Babies 

are Worth the Wait program; 

4. Review the current Texas interventions/ 

practices to reduce infant mortality; 

5. Begin development of a coordinated effort 

to reduce infant mortality; 

6. Strengthen initiatives to continue the 

reduction of infant mortality; and 

7. Identify additional activities and next steps. 

Infant mortality rate is defined as the number 

of deaths to infants less than one year of age per 

live births. The infant mortality rate has been 

used as an important indicator of the overall 

health of a community and of the access to 

health care by pregnant women and infants. 

The leading causes of infant mortality in the 

U.S. and Texas are birth defects, pre-term and 

low birth weight related disorders and sudden 

infant death syndrome (SIDS). Based on data 

from the Centers for Disease Control and 

Prevention (CDC) in 2007, the infant mortality 

rate in Texas was 6.2 deaths per 1,000 live births 

as compared to the U.S. rate of 6.8 deaths per 

1000 live births. This rate has remained relatively 

consistent. Risk factors contributing to infant 

mortality include no prenatal care, maternal 

smoking and/or alcohol use, and inadequate 

maternal weight gain. {Maternal and Infant 

SAN marcos treatment center, in continuous operation 

for more than half a century, is recruiting Texas Licensed 

Registered Nurses to become part of an experienced and 

effective treatment team. 

Our highly specialized residential programs provide 24 hour 

care to a broad spectrum of adolescent boys and girls ages 

8-17 with psychiatric, neuropsychiatric, and developmental 

disturbances. 

Please visit our website at 

www.sanmarcostc.com 

san marcos treatment center 

120 Bert Brown Road 

San Marcos, TX 78666 

Pre-employment Drug Screen, 

Health Assessment & Criminal History 

Check required 

An Equal Opportunity Employer 

Health Research: Preterm Birth, Centers for 

Disease Control and Prevention (CDC)}. 

At the conclusion of the January 2011 

meeting, the EP narrowed down the specific 

areas of interest to address the infant mortality 

issue in Texas to include: 

1. Guiding principles for the initiative; 

2. Overarching themes to be considered; 

3. Identification, collection, and use of data 

elements for interventions; 

4. Identification of potential interventions; 

5. Opportunities to implement interventions; 

6. Opportunities for including more partners 

on this initiative; 

7. Methods to communicate information about 

Healthy Texas Babies. 

A Year Later 

When the EP met again in February 2012, it 

celebrated many successes that had occurred 

over the past year related to the Healthy Texas 

Babies initiative. 

• The release of 2009 CDC infant and 

maternal health data reflecting a rate of 

6.0 deaths per 1,000 live births in Texas 

as compared to 6.8 in the U.S. (The EP 

identified that although the numbers were 

better, there was still room for improvement 

so it re-committed to the goal of reducing 

infant mortality in Texas by eight percent by 

2014). 

• The EP expanded its stakeholders to make it 

more diverse both culturally and in terms of 

disciplines represented. 

• Ten local coalitions were established and 

funded. The coalitions are charged to 

implement evidenced-based interventions 

that will impact poor birth outcomes, and 

will be reporting back to the EP periodically 

on their progress. 

• Great strides were made through various 

methods of education and communication 

in raising the awareness of the public 

and providers on issues related to infant 

mortality. 

• Research began on the development of a 

statewide communications campaign on 

HTB. 

• The HTB website – healthytexasbabies. 

org – was launched. It will serve as a hub 

of information and resources for parents, 

providers and communities. 

• DSHS and the Texas Health and Human 

Services Commission (HHSC) began 

conducting surveys of Texas hospitals to 

determine where Neonatal Intensive Care 

Units (NICU) and obstetrical (OB) units 

are within the state in an effort to improve 

access to care for high-risk pregnancies. 

• A Medicaid policy change that went into 

effect October 1, 2011, allows for nonpayment 

of pre-39 week elective inductions/ 

C-sections. 

• A Neonatal Intensive Care Unit Council was 

established by House Bill 2636. The Council 

is to develop standards for operating NICUs 

in Texas, develop an accreditation process 

for NICUs, and make recommendations 

regarding best practices to lower admissions 

to NICUs. 

• An increase in the statewide outreach of 

“text4baby” as a vehicle for public health 

announcements, outreach activities, and 

promotional materials was reported. 

• Additional work was accomplished in the 

following strategic areas: 

• Maternal Transfer Protocols 

• Texas Health Steps Module 

Development 

• Fatherhood Tools 

• Life Planning Tools 

• Maternal Mortality Review Board 

• Healthy Texas Babies Hospital 

Certification 

• Baby’s First Year Toolkit 

However, the times they are a-changin’. In 

June, 2012, the HTB’s Steering Committee (SC) 

met to consider the success and the future of 

the HTB initiative. The SC performed a SWOT 

analysis – strengths, weaknesses, opportunities 

and threats – of the HTB initiative. Based on its 

analysis, the SC recommended the creation of a 

collaborative organization that will expand the 

reach and efforts of the group to reduce infant 

mortality in Texas. It was also recommended 

that maternal health be added to the scope of 

the collaborative effort recognizing that infants 

have better outcomes when they have a healthy 

mother. 

In July 2012, the expert panel was called 

together to consider the recommendations of 

the HTB’s Steering Committee. Panel members 

were assigned to one of four topical discussion 

groups – based on the member’s area of 

expertise – to discuss activities and issues 

related to the development of a collaborative. 

The topical discussion groups were: 

1. Organizational Structure and Governance 

2. Communications 

3. Provider Education, Links to Professional 

Organizations, and Research/Publications 

4. Work Groups and Practice Committees 

At the conclusion of the July 2012 expert 

panel meeting, the steering committee was 

charged with taking the information generated 

by the topical discussion groups and developing 

a transition plan for the new Collaborative for 

discussion and feedback at the next expert 

panel meeting. 

Now, in 2013 

An expanded steering committee has 

been meeting over the past six months 

to perform research and content develop 

recommendations related to transitioning the 

initiative to a collaborative. Throughout this 

process, DSHS has been and will remain a 

committed partner to the new collaborative 

while maintaining DSHS-specific HTB activities. 

The proposed transition plan will be presented 

to the EP on March 22, 2013. 

Since its beginning, Texas Nurses Association 

has been a proud member of the Healthy Texas 

Babies Expert Panel and is now a member of the 

expanded Steering Committee. We are proud of 

the work the Healthy Texas Babies initiative has 

accomplished and look forward to the work that 

the collaborative will be involved in, in an effort 

to promote healthy Texas mothers and babies. ★


Texas Health Steps: An Update 


Texas Health Steps provides medical and 

dental check-ups and case management 

services to babies, children, teens and young 

adults – from birth through 20 years of age who 

have Medicaid – at no cost. On February 15, 

2013, the Texas Nurses Association (TNA) was 

included in a meeting of the Texas Health Steps 

Advisory Panel which provides the Texas Health 

Steps program with feedback and guidance on 

various topics of concern to the program. 

The meeting’ agenda was full with topics 

ranging from activity in the current Texas 

Legislature to lead poisoning. Highlights 

included: 

• Online Provider Modules Update: Texas 

Health Steps currently has 40 online 

modules that address various topics of 

importance to Texas Health Steps providers. 

It was reported that three modules were 

being added to the menu: child abuse 

and neglect, safe sleep, and motivational 

interviewing. 

It was suggested that a module be developed 

on ADHD (Attention Deficit Hyperactivity 

Disorder) as more and more primary care 

providers are seeing/treating children with 

ADHD. The Texas Health Steps staff is 

looking for ways to increase the utilization 

of the modules. The modules were accessed 

24,000 times last year, mainly by registered 

nurses and social workers. Advisory Panel 

recommendations included promoting the 

modules through the various state professional 

publications. All of the modules offer continuing 

education and are free. 

• Medical Transportation Program Overview: 

One of the services provided though Texas 

Health Steps is non-emergency medical 

trips. The program provides three million 

trips per year, the majority of which involve 

children under the age of 15 years. There 

has been some confusion regarding parental 

accompaniment of their children during 

a medical transport. Effective January 

1, 2013 – with full enforcement by May, 

2013 – a parent /legal guardian or a parentidentified 

adult must accompany their child 

on medical transports. The program has 

sent out 42,000 letters to involved parents 

and held parent forums in an effort to 

get the word out about the new rule and 

process. Similar information also went to 

the 15 transport services that the program 

uses. In the future, the program will report 

monitoring information back to the Advisory 

Panel. 

• Childhood Lead Poisoning Prevention 

Program: In 2012, the Centers for 

Disease Control and Prevention (CDC) 

recommended revising from 10 mcg/dL to 

5 mcg/dL the capillary and venous blood 

level for lead at which a child should be 

referred for further testing. The Advisory 

Panel is considering this recommendation. 

In addition, the Texas Health Steps staff is 

analyzing targeted testing data from select 

areas of the state in an effort to identify 

through data mapping those zip codes 

within the state that are at highest risk for 

lead poisoning, while understanding that 

the focus for the health of the children of 

Texas must be on lead poisoning prevention. 

The Texas Nurses Association was honored 

to be part of these vital conversations and looks 

forward to a continuing relationship with Texas 

Health Steps. ★ 

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Violence Against Nurses continued from page 3 

workplace safety which would lead to better 

retention of nursing staff. She stated that THA 

is in full support of the bill as are their many 

hospital members. She believes that health care 

overall will benefit from this bill becoming law. 

Testimony 6 

Linda Wagner, RN testified for the bill. She 

was a victim of a brutal assault by a patient who 

was brought in handcuffs to the emergency 

department by the police. Upon his arrival, 

Wagner asked him multiple questions about 

his history and why he was there and he did 

not indicate any specific reasons to be seen 

as a patient. He was asked if he could behave 

appropriately if the handcuffs were removed 

and he indicated that he would. 

The police officer removed the cuffs and 

left. The patient waited until Wagner was alone 

in the room with him and then exploded off 

of the stretcher, punching her in the face and 

beating her on the head. When she retreated 

to a fetal position, he continued to punch 

and hit her on the back and torso. It took nine 

people to pull the patient off of her and restrain 

him. She received multiple sutures for facial 

lacerations and had bruises all over her body. 

She is no longer working in the emergency 

room. The patient was charged with a Class C 

misdemeanor with minimal consequences. 

Testimony 7 

Cindy Zolnierek, PhD, RN, a member of the 

Texas Nurses Association, testified for the bill on 

behalf of TNA. Zolnierek has advanced practice 

clinical specialization in psychiatric-mental 

health nursing. She also has experience in 

hospital administration and is a former director 

of practice for TNA. She is currently an assistant 

professor of nursing at Texas State University. 

She spoke about some specific circumstances 

where patients are not responsible for their 

actions, e.g., persons with Alzheimer’s 

Dementia who are aggressive due to confusion 

and persons with paranoid psychosis. 

Zolnierek also emphasized that mental illness 

does not give people carte blanche for violent 

behavior as many persons can still be held 

accountable for their actions. She said that only 

five to nine percent of perpetrators are arrested 

while 11 percent are transferred to a psychiatric 

facility. According to Zolnierek, “knowledge 

of an enhanced penalty for assaultive behavior 

will reduce the occurrence of violence.” She 

classified HB 705 as “one step in the right 

direction” for emergency department staff. 

Even More Testimony 

Speakers against the bill included Christian 

Edward of the Texas Criminal Defense 

Association, Greg Hansch of the National 

Alliance of Mental Illness of Texas, and Gyl 

Switzer of Mental Healthcare of Texas. Their 

concerns have to do with how this could 

affect patients with mental illness. Edward also 

asserted that nurses are covered under current 

law so this bill is not needed. 

Anna Gray with Texas Catalyst of 

Empowerment spoke on the bill. She stated 

that she has extreme respect for emergency 

room staff but has concerns about the mentally 

ill. She believes that this bill will not help the 

situation. 

Meagan Longley with the Heart Foundation 

spoke on the bill. She said that the safety of 

emergency personnel is paramount but that 

the bill is nonspecific about the de-escalation 

training and how it will be provided. Patrick 

Waldron with the Texas Department of State 

Health Services was present as a resource 

witness. There were no questions for him. James 

Willmann, JD of the Texas Nurses Association 

spoke in support of the bill and clarified 

that current law only covers field personnel. 

Steven T. of Bexar County Emergency Planning 

Committee spoke for the bill and reiterated that 

current law only covers field personnel. At the 

end of the hearing, the Criminal Jurisprudence 

Committee members were overall supportive 

of the concept of this bill after several of them 

had asked repeatedly why a change was needed 

because they felt existing law should cover this. 

The testimony by nurses demonstrates how 

being part of the Nursing Legislative Action 

Coalition (NLAC) can strengthen the delivery 

of the message. Texas Emergency Nurses 

Association and Texas Organization of Nurse 

Executives are members of NLAC which is 

hosted by the Texas Nurses Association. The 

coalition has been collaborating on this issue 

the past year during its meetings to craft the 

message and be consistent in the delivery of the 

message. An important thread in the dialogue 

was to increase penalties for those who 

deliberately and intentionally assault nurses 

and nursing staff in the emergency room while 

excluding patients who have assaulted someone 

as a result of their illness. 

References 

1 Gacki-Smith, J., Juarez, A.M., Boyett, L., Homeyer, C., 

Robinson, L., & MacLean, S.L. (2009). Violence against 

nurses working in US emergency departments. Journal of 

Nursing Administration. 39:7/8, 340-349. 

2 U.S. Department of Justice, Office of Justice Programs, 

Bureau of Justice Statistics, Special Report: Workplace 

Violence, 1993-2009, National Crime Victimization Survey 

and the Census of Fatal Occupational Injuries, March 2011. 

3 Bureau of Labor Statistics, U.S. Department of Labor, 2011. 

About the Author: Ellarene Duis Sanders, PhD, RN, 

NEA-BC is currently interim executive director, Texas Nurses 

Association. 

Helping Caregivers Maintain 

Their Own Health 

by Joyce Pohlman 

To address health and other issues often 

faced by caregivers, the Texas Respite 

Coordination Center, in collaboration with 

the Texas Department of Aging and Disability 

Services (DADS), has created the Take Time 

Texas website, www.taketimetexas.org. 

Take Time Texas is the first statewide 

clearinghouse of information for caregivers 

and providers of respite services in Texas. The 

website includes an inventory of more than 

1,000 respite care providers that makes it easier 

for caregivers to find respite care. Caregivers 

The Harris County Sheriff’s Office is currently recruiting for health care 

staff to provide efficient, effective and compassionate health care to 

a unique population. The HCSO is the largest jail in the country to be 

accredited by the National Commission on Correctional Health Care. We 

offer challenging and rewarding clinical opportunities with competitive 

salary, retirement, paid holidays and other benefits. The HCSO is currently 

recruiting for the following positions: 

RNs, LVNs, & NP/PA 

Physician & Case Manager 

Please contact Bobby D. Davis, Medical Administrator 

1200 Baker Street, Houston, TX 77002 at 713.755.7223. 

Apply online at www.hcsojobs.com 

can search the inventory by name, county 

served, type of respite provided, age group 

served or type of provider. 

The website also provides a wide range of 

caregiver education and training materials, 

including self-assessment tools, information 

on identifying and managing stress related to 

caregiving, disease-specific information, and 

educational programs. Health professionals can 

benefit from outreach and marketing materials 

included on the website. These materials 

include downloadable high quality brochures 

that can be distributed to clients to inform them 

about the value of respite care. 

The estimated 2.7 million caregivers in Texas 

play a significant role in helping people who 

are older and those with disabilities remain 

at home. Their support with daily tasks, such 

as meal preparation, transportation, bathing 

and dressing helps seniors and persons with 

disabilities maintain their well-being and delay 

or forgo institutionalization. 

However, the physical demands of caregiving 

– lifting and turning, bedding changes, bathing 

and moving the care recipient from the bed 

to a chair – cause caregivers to have more 

health problems than non-caregivers. 1, 2 Since 

beginning their caregiving roles, more than 

80 percent say their sleeping is worse, more 

than 60 percent say their eating habits are 

worse and 70 percent report not going to the 

doctor as often as they should. 3 Additionally, 

20-50 percent of caregivers report depressive 

disorders or symptoms. 4 

Respite care gives caregivers a break from 

their responsibilities and allows them to 

restore and strengthen their ability to continue 

providing care. A recent survey by the Texas 

Health and Human Services Commission found 

that more than 90 percent of caregivers agreed 

that respite care would reduce their stress. 

However, more than half had not used respite 

care. Another 32 percent had tried to use respite 

care but were unable to find it. 5 

References 

1. Texas Department of Aging and Disability Services. 

(2009). Informal Care in Texas: Aging Family Caregivers and 

their Need for Services and Support. 

2. Shultz, R., O’Brien, A. Bookwala, J. and Fleissner, 

K. (1995). Psychiatric and physical morbidity effects of 

dementia caregiving: Prevalence, Correlates, and Causes. The 

Gerontologist, 35, 771-191. 

3. National Alliance for Caregiving and Evercare. (2006) 

Evercare Study of Caregivers in Decline. As referenced in, 

Texas Department of Aging and Disability Services, Informal 

Care in Texas. 

4. National Family Caregiver Alliance. (n.d.) Selected 

Caregiver Statistics. As referenced in, Texas Department of 

Aging and Disability Services, Informal Care in Texas. 

5. Texas Health and Human Services Commission (2013) 

Unpublished Results of Caregiver Survey. 

About the Author: Joyce Pohlman is a Grants Coordinator 

at the Texas Department of Aging and Disability Services. In 

this capacity, she oversees state and federally funded programs 

designed to improve the delivery and coordination of respite 

care in Texas. ★


Forces and Factors, Issues and Influencers: 

Knowledge Nurses Need to Lead 

Headed Your WaY in 2013! 

September 12 – Lubbock, 

Overton Hotel & Conference Ctr. 

September 20 – Las Colinas 

(Dallas area), Omni Mandalay 

Hotel at Las Colinas 

October 9 – San Antonio, 

Menger Hotel 

November 6 – Houston, Crowne 

Plaza Houston – Brookhollow 

Just 13 years ago, Texas Nurses 

Association held its first Annual 

Nursing Leadership Conference. It 

was 2001 and nursing was on the 

brink of huge transformation. Over 

two full days, TNA offered conference 

attendees knowledge – updates on 

new legislation and regulations 

that would soon impact daily 

practice. And it brought to Austin 

well known, highly regarded 

national speakers to share new 

research and perspective on 

the issues and factors soon to 

influence nursing in Texas. 

It’s now 2013. Today’s nursing 

environment has shifted from 

exploration and contemplation to 

implementation – to collaboration, 

to education progression, to every 

nurse has a leadership role in 

moving nursing forward. Now more 

than ever, there is advantage to 

every nurse having up-to-date 

knowledge about new legislation, 

Nursing Practice Act amendments, 

and new regulations that will affect 

practice. It’s knowledge every nurse 

needs to lead. 

This year, Texas Nurses Association is 

changing the format of its Annual 

Nursing Leadership Conference. 

This year, it’s going on the road and 

headed to a city near you. Whether 

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NEW RESOURCES FOR NURSES AVAILABLE FROM 

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These pocket guides are resources no direct care nurse should be without! 

Two of TNA’s most popular, pocket-sized resources are updATed for 2013 and available for order online at texasnurses.org. 

The Texas Hospital Safe 

Staffing Law contains useful 

information on how to best question 

a patient assignment and advocate 

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Included is simple, direct guidance 

on when and how to request 

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fears duty to patient is at risk. 

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Nurses Taking Action in Texas: A Series 

Commander James L. Dickens, 

DNP, RN, NP-C, FAANP 

by Alexia Green, PhD, RN, FAAN 

So how does a day start for a senior 

program officer, U.S. Public Health 

Service, Office of Minority Health Service 

in the Office of the Assistant Secretary 

for Health, U.S. Department of Health 

and Human Services? Ninety days ago 

it started with a phone call that he was 

being deployed to Saipan and needed to 

leave within 24 hours. Saipan? 

You might wonder as I did, where is 

Saipan? Well, Saipan is a Pacific island, 

the largest of the three islands (Saipan, 

Tinian and Rota) in the Commonwealth 

of the Northern Mariana Islands, and a 

U.S. territory. The islands are north of 

Guam by 100 miles or so. Relevant to 

Commander (CDR.) Cmdr. Dickens’ deployment, Saipan has a public 

hospital. 

Even though CDR Dickens says of himself, “I’m just a public servant,” 

he is a unique Texas nurse. He serves in the U. S. Public Health Service 

Commissioned Corps which focuses on protecting, promoting and 

advancing the health and safety of our Nation. Yes, that includes 

territories such as Saipan. The Public Health Service Commissioned 

Corps is one of the seven Uniformed Services (five armed forces - 

Army, Marine Corps, Navy, Air Force, Coast Guard; and two other - 

Public Health Service Commissioned Corps and National Oceanic and 

Atmospheric Administration Commissioned Corps) that responds to 

national disasters and public health needs and provides leadership in 

public health practices. 

In the case of Saipan, CDR Dickens served as a subject matter expert 

advising senior leaders of the 100-bed hospital on plans for correcting 

patient care delivery problems and on monitoring the hospital for future 

sustainability. He called upon earlier career experience working for the 

Centers for Medicare & Medicaid Services (CMS), when he taught state 

surveyors best practices for hospitals and the expectations of CMS. 

Wearing a different career hat, CDR Dickens is also the Minority 

Health Consultant for Region VI (Dallas) in the Office of the Assistant 

Secretary for Health. He and his wife – also a nurse and a practicing 

midwife – have two grown children who were raised in this unique 

household of “nurse parents.” In his second role, CDR Dickens focuses 

on minority health issues across America’s Southwest region. His 

responsibilities might take him to a Hopi Indian Reservation in New 

Mexico or Arizona or to the U.S. border areas where he focuses on 

assuring border health issues are addressed. 

What has happened since CDR Dickens received his phone call to 

leadership nearly 18 months ago is that advanced practice nursing has 

tirelessly worked together – and with medicine – to collaborate on 

legislation that all sides can endorse. Said CDR Dickens, “If no one’s 

completely satisfied with the pending legislation, we at least believe we 

have a product that will effectively work.” 

The problem that has existed, relayed CDR Dickens, is that the existing 

model of APRN practice was difficult to understand and the expectations 

weren’t clear. SB 406/HB 1055 clarify roles and responsibilities. CDR 

Dickens calls it, “a consolidated model for clarity.” 

As CDR Dickens summarized it, “We have a strong chance of moving 

this legislation forward. The most important thing is that at the end of the 

day, it’s really about the beneficiaries of our APRN services – the patients 

and the citizens of Texas.” 

About the Author: Alexia Green, PhD, RN, FAAN is associate professor 

and dean emerita at Texas Tech University Health Sciences Center School 

of Nursing. She is also co-chair of Texas Team Action Coalition executive 

committee, and co-leader of its Tactical Support & Operations Team. She was 

appointed by Gov. Perry in 2012 to serve on the Texas Institute for Healthcare 

Quality and Efficiency and is currently the only nurse on that board. 

More About CDR James Dickens: In his spare time, Dickens is a member 

of numerous professional organizations. He is a Fellow of the American 

Association of Nurse Practitioners and president of the American Nurse 

Practitioner Foundation. He has over 20 years of combined federal health care 

experience that prepares him well for his role in serving our country. Dickens 

graduated from Texas Tech University Health Sciences Center in May 2012 with 

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Another Call to Action 

Just as a phone call deployed him to Saipan, another phone call thrust 

CDR Dickens into an unexpected leadership role in moving forward what 

has become key legislation (SB 406/HB 1055) this session for advanced 

practice registered nurses (APRN). CDR Dickens recalls that phone call. 

“I was pulled off the bench,” he said, “and put in the starting rotation.” 

It seems a disabled aircraft left one leader stranded and resulted in CDR 

Dickens being “called into action” to facilitate an important meeting 

of a number of APRN groups working in concert with Texas Nurses 

Association and the Texas Team Advancing Health through Nursing 

Action Coalition, convened to advance the Future of Nursing: Campaign 

for Action. 

As an APRN and a member of the Texas Team Strategic Advisory 

Committee, CDR Dickens was a natural for the facilitator assignment and 

an obvious choice. Modestly he recalls, “Efforts had already begun to 

bring the APRN groups together on unified legislation that could clarify 

the roles and responsibilities, and relationships with physicians in the 

advanced practice nursing model. I just picked up the torch.” 

Actually, efforts over recent legislative sessions hadn’t progressed 

much or yielded any passed legislation. In fact, the last significant 

legislation for APRNs was passed in 2003 when agreement was reached 

with medicine on expanding prescriptive authority for APRNs. That was 

followed by a two-session moratorium (2005, 2007) and two sessions 

(2009, 2011) of an unsuccessful attempt to achieve authority to prescribe 

without physician delegation.

Page 18 • Texas Nursing Voice April, May, June 2013


WE DEFEND NURSES 

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STEPS-0468_TxNursingVoice_5X7n5_MJJ.indd 1 

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STEPS-0467_TxNursing_10n25X7n5_MAY_JUNE.indd 1 

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Texas Nurses Association - Arthur L Davis Publishing

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