Kentucky Nurse - Jan. 2014

An Award Winning Publication 

THE OFFICIAL PUBLICATION OF THE KENTUCKY NURSES ASSOCIATION 

Circulation 72,000 to All Registered Nurses, LPNs and Student Nurses in Kentucky 

Kentucky Nurses 

Association Calendar 

of Events 2014 

Page 10 

Personal Experience 

Trackside Partnership 

Produces Multiple Winners 

Page 12 

President’s Pen 

The Evolution of ANA/KNA Promises a Bright Future 

2013 has been an exciting 

year for the Kentucky Nurses 

Association (KNA). KNA was 

the first in the nation to take 

the bold step of volunteering 

in 2012 to serve as a pilot 

for the American Nurses 

Association (ANA) national 

and state membership 

campaign. ANA House of 

Delegates members that 

year had requested evidence 

to demonstrate effective Kathy Hall 

membership recruitment 

strategies. Kentucky is now one of three pilot 

markets, building that body of evidence, putting 

Kentucky in the forefront of this key endeavor. 

KNA launched its membership campaign “Five 

in Five” in August 2013. KNA Board Members, 

serving as the Recruitment Campaign Committee, 

committed to recruiting 5 members each in 5 

months, with Dr. Kathy Hager serving as Director 

of Membership Development. Maureen Keenan, 

KNA Executive Director, presented this model along 

with educational materials in June at an early 

morning ANA breakfast meeting for the three pilot 

groups during the charter ANA Members Assembly. 

There were lots of questions, and KNA was well 

represented. 

A number of nurses belong to more than one 

professional organization, but ANA/KNA is the 

ONLY organization that speaks with one voice 

for the welfare of ALL nurses. The new ANA/KNA 

annual membership dues of $11.00 per month or 

current resident or 

Presort Standard 

US Postage 

PAID 

Permit #14 

Princeton, MN 

55371 

$126 per year provides all nurses the opportunity 

to get the most current nursing information, obtain 

contact hours through free continuing education 

programs, or at a nominal charge as well as being 

represented at the table when issues affecting 

nursing arise. ANA operates with 90% of the 

staff it did two years ago, strategically dedicating 

resources for technology. ANA’s transition from the 

House of Delegates annual meeting (with more than 

600 representatives from all the states/territories) 

to the Members Assembly annual meeting 

(with about 250 representatives in attendance) 

streamlines the decision making process including 

the use of an automatic response system. 

Why am I optimistic that KNA’s relevance will 

continue in 2014? At the KNA Business Meeting 

held during the Education Summit 2013, Bylaws 

revisions were approved to move from a structure 

of “Districts,” defined by geographic regions, to 

“Chapters.” A chapter is focused on a common 

interest with a minimum number of individuals 

to petition/start the group-geography may be 

irrelevant. A KNA member may join as many 

chapters as they wish. Those districts wishing to 

remain intact based on geography may still do so. 

This model will serve KNA by improving financial 

accountability and connecting new members to 

those with like interests (sometimes a missing 

link in the past). Emphasis is on developing 

communities of common interest. 

The “Task Force on Chapters” as directed by 

the KNA Board had explored strategies to find a 

model of similar size and demographic to KNA. 

That group recommended that KNA: “1. Utilize 

the Chapter Structure at the Georgia Nurses 

Association as a model, and 2. Pursue a process 

with the KNA membership to inform them of 

the motivation and rationale to restructure 

into chapters and seek feedback, suggestions, 

and questions/concerns about moving into 

a chapter structure from district leadership 

and KNA membership.” Key for the success 

of KNA in implementing the transition from 

districts to chapters has been the education 

provided to districts on the front end by 

many miles covered by the executive director 

to attend district meetings and provide 

the face to face communication necessary. 

Feedback received was incorporated into this 

process. KNA has outstanding leadership 

at the district level that could envision and 

embrace a different model to meet the needs of 

current and growing membership. To date (since 

this goes in early November for publication in 

January), I have personally been provided petitions 

by two Districts (District 2 and District 9) who have 

now become Chapters. 

The KNA Education Summit 2013 

“Understanding the Social Determinants of Health” 

was held at the Capitol Plaza Hotel in Frankfort 

in October. Based on feedback from both KNA 

members and students, this day long continuing 

nursing education program was deemed a huge 

success with outstanding presenters. “Surviving 

Your First Year” will once again be offered in 

2014 with the addition of a day to cover clinical 

topics. KNA will host its Convention in Fall 2014. 

Encourage current and future professionals to 

participate in submitting abstracts for the Poster 

Session. There is a wide variety of topics/interests 

that are then published in KY Nurse. 

Finally, Maureen Keenan and Teresa H. Huber 

will have returned from ANA Leadership Training 

with other state representatives in December. 

Visibility at the national level is key for KNA to 

stay abreast of changes affecting all of health care. 

Your leadership at the Chapter (or formerly District 

level) or other capacity in which you serve KNA is 

greatly appreciated. You ARE KNA! To all of our new 

members, Welcome, and thank you for encouraging 

others to join! 

Highlights 

President’s Pen . . . . . . . . . . . . . . . . . . . . . 1 

Accent on Research . . . . . . . . . . . . . . . . . . 3 

Student Spotlight . . . . . . . . . . . . . . . . . . 4-7 

Personal Experience . . . . . . . . . . . . . . . . . . 8 

The Road to Legislative Mandate of 

HPV Vaccination in Kentucky . . . . . . .9-10 

KNA Calendar of Events 2014 . . . . . . . . . . 10 

Access to Healthcare: Removing Barriers 

for the APRN. . . . . . . . . . . . . . . . . . . . . 11 

Welcome New Members . . . . . . . . . . . . . . . 13 

Membership Application . . . . . . . . . . . . . . 13

INFORMATION FOR AUTHORS 

Kentucky Nurse Editorial Board welcomes submission 

articles to be reviewed and considered for publication in 

Kentucky Nurse. 

 

 

 

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by a signed Kentucky Nurse transfer of copyright form 

(available from KNA office or on website www.Kentucky- 

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only if accompanied by the 

signed transfer of copyright form and will be considered for 

publication on condi tion that they are submitted solely to 

the Kentucky Nurse. 

 

one side of 8 1/2 x 11 inch white paper and submitted in 

triplicate. Maximum length is five (5) typewritten pages. 

 

or electronically 

 

name(s), title(s), affiliation(s), and complete address. 

 

6th edi tion. 

 

 

author(s). Following review, the author(s) will be notified of 

acceptance or re jection. Manuscripts that are not used will 

be returned if accompa nied by a self-addressed stamped 

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Kentucky Nurse editors reserve the right to make final 

editorial changes to meet publication deadlines. 

 

Editor, Kentucky Nurse 

Kentucky Nurses Association 

P.O. Box 2616 

Louisville, KY 40201-2616 

(502) 637-2546 

Fax (502) 637-8236 

or email: CarleneG@Kentucky-Nurses.org 

RN First Assistant Program 

A Partnership between NKU and 

St. Elizabeth Healthcare (Edgewood) 

Provides didactic and hands-on preparation needed to 

assume the role of the first assistant in operative and 

invasive procedures. 

Spring Course Dates: March 17-21, 2014 

For information email: berlingv1@nku.edu 

Carmel Manor 

“Six Decades of Loving Care!!!” 

We offer Personal, Skilled Care and Rehab Services 

Located just outside of Cincinnati—we have a beautiful location 

overlooking the Ohio River. 

Serving the Northern Kentucky/greater Cincinnati area. 

Carmel Manor is a 145-bed nursing facility—looking for RNs 

for a “long term” commitment. 

Schedule a visit with us—you will feel the difference!! 

Carmel Manor Rd. 859-781-5111 

Ft. Thomas, KY 

The Kentucky Association of Health 

Care Facilities Congratulates our 

2013 Nursing Award Winners 

2013 Director of Nursing 

Kim Hobson 

Nazareth Home 

2013 Administrative Nurse 

Allyson Stovall 

Kindred Nursing and Rehabilitation – 

Maple Manor 

2013 Nurse – RN 

Jeanne Chandler 

Jefferson Place 

2013 Nurse – LPN 

Melissa Mull 

Jefferson Place 

For information on long-term care career opportunities 

contact KAHCF at 502-425-5000 

District Nurses Associations 

Presidents 2013 

#1 Carolyn Claxton, RN H: 502-749-7455 

1421 Goddard Avenue 


E-Mail: CarolynClaxton@yahoo.com 

#2 Ella F. Hunter, RN H: 859-223-8729 

94 Summertree Drive 

Nicholasville, KY 40356 

E-Mail: ellafayhunter@yahoo.com 

#3 Deborah J. Faust, MSN, RN H: 859-655-1961 

2041 Strawflower Court 

Independence, KY 41051 

DJFaust11@gmail.com 

#4 Kathleen M. Ferriell, MSN, BSN, RN H: 502-348-8253 

125 Maywood Avenue W: 270-692-5146 

Bardstown, KY 40004 

E-Mail: Kathleen. Ferriell@lpnt.net 

#5 Nancy Armstrong, MSN, RN H: 270-435-4466 

1881 Furches Trail W: 270-809-4576 

Murray, KY 42071 

E-Mail: Narmstrong1@murraystate.edu 

#6 OPEN 

#7 Lorraine B. Borman, RN H: 270-745-2718 

242 Bowlie Avenue 

Bowling Green, KY 42101 

E-Mail: lorraine.bormann@wku.edu 

#8 Marlena Buchanan, RN W: 270-831-9735 

7475 Highway 283 

Robards, KY 42452 

E-mail: marlena.buchanan@kctcs.edu 

#9 Peggy T. Tudor, EdD, MSN, RN H: 859-548-2540 

21 Trail Lane 

Lancaster, KY 40444-9578 

E-Mail: peggy.tudor@eku.edu 

#10 OPEN 

#11 Loretta J. Elder, MSN, RN, CAPA H: 270-667-9801 

1150 Baptist Hill Road 

Providence, KY 42450 

E-Mail: lelder0001@kctcs.edu 

 

 

 

Contact Linda Thomas, lthomas2@murraystate.edu 

 

Contact the School of Nursing, 270-809-2193 

 

 

 

 

Contact: 

Dina Byers, PhD, APRN, ACNS-BC 

dbyers@murraystate.edu 

270-809-6223 

More than 15 years experience in educating 

advanced practice nurses to meet the complex 

health care needs of society. 

Strong faculty committed to excellence in 

education and practice. 

 

 

“The purpose of the Kentucky Nurse shall be to convey information 

relevant to KNA members and the profession of nursing and practice of 

nursing in Kentucky.” 

Copyright #TX1-333-346 

For advertising rates and information, please contact Arthur L. Davis 

Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, 

Iowa 50613, (800) 626-4081, sales@aldpub.com. KNA and the Arthur L. 

Davis Publishing Agency, Inc. reserve the right to reject any advertisement. 

Responsibility for errors in advertising is limited to corrections in the next 

issue or refund of price of advertisement. 

Acceptance of advertising does not imply endorsement or approval 

by the Kentucky Nurses Association of products advertised, the 

advertisers, or the claims made. Rejection of an advertisement does 

not imply a product offered for advertising is without merit, or that the 

manufacturer lacks integrity, or that this association disapproves of the 

product or its use. KNA and the Arthur L. Davis Publishing Agency, Inc. 

shall not be held liable for any consequences resulting from purchase 

or use of an advertiser’s product. Articles appearing in this publication 

express the opinions of the authors; they do not necessarily reflect views 

of the staff, board, or membership of KNA or those of the national or local 

associations. 

The Kentucky Nurse is published quarterly every January, April, 

July and October by Arthur L. Davis Publishing Agency, Inc. for Kentucky 

Nurses Association, P.O. Box 2616, Louisville, KY 40201, a constituent 

member of the American Nurses Association. Subscriptions available 

at $18.00 per year. The KNA organization subscription rate will be $6.00 

per year except for one free issue to be received at the KNA Annual 

Convention. Members of KNA receive the newsletter as part of their 

membership services. Any material appearing herein may be reprinted 

with permission of KNA. (For advertising information call 1-800-626- 

4081, sales@aldpub.com.) 16mm microfilm, 35mm microfilm, 105mm 

microfiche and article copies are available through University Microfilms 

International, 300 North Zeeb Road, Ann Arbor, Michigan 48106. 

2014 EDITORIAL BOARD 

EDITORS 

Ida Slusher, PhD, RN, CNE (2013-2016) 

Maureen Keenan, JD, MAT 

MEMBERS 

Trish Birchfield, PhD, RN, ARNP (2012-2015) 

Donna S. Blackburn, PhD, RN (2011-2014) 

Patricia Calico, PhD, RN (2012-2015) 

Sherill Cronin, PhD, RN, BC (2011-2014) 

Joyce E. Vaughn, BSN, RN, CCM (2013-2016) 

REVIEWERS 

Donna Corley, PhD, RN, CNE 

Dawn Garrett-Wright, PhD, RN 

Elizabeth “Beth” Johnson, PhD, RN 

Connie Lamb, PhD, RN, CNE 

Deborah A. Williams, EdD, RN 

KNA BOARD OF DIRECTORS 

PRESIDENT 

Kathy L. Hall, MSN, BSN, RN (2012-2014) 

IMMEDIATE PAST-PRESIDENT 

Mattie H. Burton, PhD, RN, NEA-BC (2012-2014) 

PRESIDENT-ELECT 

Teresa H. Huber, MSN, RN (2013-2016) 

VICE-PRESIDENT 

Michael Wayne Rager, DNP, PhD(c), FNP-BC, APRN, CNE 

SECRETARY 

Beverly D. Rowland, MSN, RN, CNE (2013-2015) 

TREASURER 

Kathy Hager, DNP, ARNP, CFNP, CDE (2012-2014) 

DIRECTORS-AT-LARGE 

OPEN (2012-2014) 

OPEN (2013-2015) 

Peggy T. Tudor, MSN, RN, CDE, EdD (2013-2015) 

Jo Ann Wever, MSN, RN (2012-2014) 

EDUCATION & RESEARCH CABINET 

Liz Sturgeon, PhD, RN, CNE (2012-2014) 

GOVERNMENTAL AFFAIRS CABINET 

Joe B. Middleton, MSN, RN, CEN, CC/NRP (2013-2015) 

PROFESSIONAL NURSING PRACTICE & ADVOCACY 

CABINET 

OPEN (2014) 

KNF PRESIDENT 

OPEN 

KANS CONSULTANT 

Tracy S. Patil, EdS, MSN, RN 

KNA STAFF 

EXECUTIVE DIRECTOR 

Maureen Keenan, JD, MAT 

ADMINISTRATIVE COORDINATOR 

Carlene Gottbrath 

www.kentucky-nurses.org 

Published by: 

Arthur L. Davis 

Publishing Agency, Inc.

Accent On Research 

Submitted by: Tina Lucas, Pam Luthin and 

Mark Stim, BSN students at 

Bellarmine University, Louisville, KY 

As nurses, we have all had patients and families 

question the results of the automatic blood pressure 

machine compared with the manual blood pressure 

method. Many medications have “hold” parameters 

based on blood pressure and accurate blood 

pressures (BPs) are essential. 

A group of nurse researchers recently conducted 

a study to determine if automated blood pressure 

machines were as accurate as manual blood 

pressure cuffs, since blood pressure measurements 

are used to determine if patients can receive 

certain medications in the psychiatric setting. 

The researchers conducted the study in a 14-bed 

psychiatric unit at Cooper University Hospital in 

southern New Jersey. There were 42 participants 

(27 men, 15 women); patients who were confused, 

morbidly obese, (BMI > 39) unable to have a BP 

reading taken on an upper arm, were unable 

to give informed consent, or had used nitrates, 

bronchodilators, other medications or had 

treatments that could affect BP readings in the last 

thirty minutes were excluded. The mean age of the 

participants was 42.9 years and the mean BMI was 

27.1. 

First, informed consent was obtained from 

each eligible participant. The purpose of the study 

DATA BITS 

“That Blood Pressure Machine 

Doesn’t Work Right on ME!” 

was explained and each patient was given an 

opportunity to ask questions. Next, the date, the 

patient’s gender and age were noted. Patients were 

randomly assigned to one of two groups. Group 

one had the manual BP taken first followed by the 

automated pressure; group two had the automated 

BP taken first. Pressures were taken only by trained 

investigators and followed strict study procedures to 

assure consistency of the method used. 

A significant difference was found in the systolic 

BPs (top number) (p

Student Spotlight 

Lesbian, Gay, And Bisexual Adolescent Suicidality: The Impact Of Social Stigma 

Anthony Carney 

Nursing Student 

University of Kentucky College of Nursing 

Lexington, Kentucky 

Purpose 

Lesbian, gay and bisexual (LGB) adolescents 

have a fourfold greater risk of attempting suicide 

than their heterosexual counterparts (Kahn, Olsen, 

McManus, Kinchen, Chyen, Harris & Wechsler, 2011). 

Attention to this disparity has been limited, in part, 

because neither the U.S. Vital Statistics nor the 

National Violent Death Reporting System identifies 

sexual orientation or gender identity in victims. 

Therefore, it is not precisely known how many 

suicides in recent years were related to issues with 

sexual orientation (U.S. Department of Health and 

Human Services (HHS) Office of the Surgeon General 

and National Action Alliance for Suicide Prevention, 

2012). The purpose of this review is to explore 

whether the social stigma of being homosexual in a 

heteronormative society (i.e., a viewpoint that values 

heterosexuality as the norm, rather than one of 

many possibilities), plays a part in the hesitancy of 

LGB adolescents to seek mental health care. 

Problem 

Identity formation is a key aspect of adolescent 

psychosocial development. The impact of being 

different from their peers, sexual non-conformity and 

the resultant stress is well documented (McAndrew 

& Warne, 2010). In a survey of 31,852 Oregon 

teenagers, 25.1% of LGB youth reported suicidality 

compared to 4.2% of heterosexual adolescents 

(Hatzenbuehler, 2011). One researcher found that 

significantly more LGB youth had thoughts of suicide 

than did their heterosexual peers (73 % compared to 

53%). This study included heterosexual males and 

females (n = 366) and gay, lesbian, and bisexual (n 

= 63) homeless and runaway adolescents from the 

first wave of a longitudinal study of homeless youth 

(Whitbeck, Chen, Hoyt, Tyler, & Johnson, 2004). 

Suicidal behaviors in LGB populations appear to 

be related to “minority stress,” which comes from 

prejudice attached to minority sexual orientation 

and gender identity. Homophobia, stigma, and 

discrimination are elements of minority stress 

that can negatively affect mental health of the LGB 

adolescent population (USDHHS, 2012). Homophobia 

can be present in discrimination through laws and 

policies that omit LGB people from benefits and 

protections granted to others. Social stigma plays 

a part in LGB adolescent suicidality by preventing 

the LGB population from accessing health care 

that is responsive to LGB health issues (American 

Psychological Association, 2008). Discrimination has 

been associated with suicide, depression, substance 

abuse, PTSD, anxiety disorders, HIV/AIDS and 

other sexually transmitted diseases (American 

Psychological Association, 2008). 

Method 

A literature review was conducted using Cinahl 

and PubMed with the keywords “homosexual,” 

“mental health,” “suicide,” “sexual orientation” 

“adolescent” and “health care.” Search filters were 

set to only include articles in English and to exclude 

studies related to the adult LGB population. 

Evidence 

Four quantitative studies, six qualitative studies, 

and two informational articles from the American 

Psychological Association and the United States 

Surgeon General were reviewed. The evidence shows 

there is a definite correlation between minority 

sexual orientation and suicidality. Few studies 

explored specific treatment modalities to help 

LGB adolescents from destructive behaviors such 

as suicide, substance abuse, unsafe sex, etc. The 

evidence suggests the need for gay-affirmative role 

models and empowerment of sexual identity for 

adolescents (Horn & Romeo, 2010). 

Lesbian, gay, and bisexual adolescents have 

been shown to have different risk factors/markers 

for suicidality compared to heterosexuals. Analysis 

of the National Longitudinal Study of Adolescent 

Health shows that the typical risk factors of binge 

drinking, drug use, and depression were associated 

with elevated risk for suicidal ideation and suicide 

attempts among heterosexual adolescents. However, 

the increased risk for suicide attempts among LGB 

adolescents was not associated with these risk 

factors. Social stigma, bullying, and internalized 

homophobia are results of living in a non-supportive 

environment for LGB youth, and should be 

considered important risk factors for suicidality in 

the group (Silenzio, Pena, Duberstein, Cerel, & Knox 

2007). Internalized homophobia refers to beliefs, 

stigma, and prejudice about LGB people that persons 

with same-sex attraction turn inward on themselves 

(Herek, 2004). 

Mental health professionals are not equipped 

with the cultural competence to address the 

needs of the LGB adolescent population because 

education relating to the culturally sensitive care of 

the LGB population is lacking. Many young people 

seeking professional help for suicidality experience 

heterosexism (i.e., a bias in favor of individuals who 

engage in heterosexual relationships) from health 

care workers (McAndrew & Warne 2012). Silence 

among heterosexual professionals, which ignores 

sexual orientation as a factor in care provision, has 

exacerbated the problems experienced by LGB clients 

in accessing sensitive health care (McAndrew & 

Warne, 2012). Rather than empowering adolescents 

with their emerging sexuality, the attitude of the 

social environment often leads to continuing the gay 

child’s need to stay hidden. Children who feel the 

need to hide their sexual identity within their social 

environment will often experience feelings of shame 

and worthlessness (Bird, Kuhns, & Garofalo, 2011). 

Mental health nurses and public health nurses 

are in excellent positions to save lives of LGB 

adolescents by promoting resilience in LGB teens and 

fostering positive self-worth. Factors that promote 

resilience in LGB people include family acceptance, 

a sense of safety, positive sexual/gender identity, 

and the availability of culturally appropriate mental 

health treatment. Mental Health professionals can 

reduce suicidal behaviors in LGB populations by 

decreasing sexual orientation prejudice and stressors 

related to gender conformity; improving identification 

of depression, anxiety, substance abuse, and other 

mental disorders; increasing availability and access 

to LGB-specific treatments and mental health 

services; identifying and reducing bullying and other 

forms of victimization; enhancing family acceptance; 

and changing discriminatory laws and public policies 

(U.S. Department, 2012). 

Discussion 

An important measure to improve mental health 

in LGB adolescents includes communities starting 

to challenge the idea that heterosexuality and gender 

conformity are the only acceptable options for LGB 

adolescents (Horn & Romeo, 2010). Education of 

adults to affirm sexual difference with nurturance is 

extremely important (McAndrew & Warne, 2012). The 

promotion of positive role models for LGB adolescents 

is important because research suggests having a 

support person decreases negative health behaviors 

and suicidality (Bird, Kuhns, & Garofalo, 2011). 

This may be accomplished through development of 

gay-straight alliances in schools and community 

organizations that target LGB adolescents, or media 

campaigns such as the Trevor Project and the “It 

Gets Better” project. The Trevor Project is a national 

organization focused on crisis and suicide prevention 

among lesbian, gay, bisexual, transgender, and 

questioning (LGBTQ) youth. The “It Gets Better” 

campaign mission is to “communicate to lesbian, 

gay, bisexual and transgender youth around the 

world that it gets better, and to create and inspire 

the changes needed to make it better for them” (www. 

itgetsbetter.org, 2013, para. 1 ). 

As responsible and accountable professionals 

delivering mental health care, healthcare workers 

need to increase their knowledge of the issues 

facing young LGB people and disseminate that 

knowledge to the community. A possible way to 

expand knowledge about the health needs of LGB 

youth is diversity focus groups included in annual 

competencies for healthcare workers. This would be 

an excellent method to provide education as well as 

an opportunity for discussion by healthcare workers 

in an open, nonjudgmental environment (McAndrew 

& Warne, 2010). 

Conclusion 

Nearly thirty years ago, homosexuality was 

removed from the DSM as “deviant behavior.” More 

and more states are approving gay marriage status, 

and gay rights have been brought to the forefront 

in the United States. However, despite the changing 

social structure, clinicians still may be unequipped 

with the skills to help treat the needs of LGB clients. 

As care providers at the forefront of public health, 

nurses should be equipped with the knowledge 

and skills to promote psychological health in this 

population. 

References 

American Psychological Association. (2008).Answers 

to your questions: For a better understanding 

of sexual orientation and homosexuality. 

Washington, DC [Retrieved from www.apa.org/ 

topics/sorientation.pdf.] 

Bird, J. P., Kuhns, L., & Garofalo, R. (2012). The 

impact of role models on health outcomes for 

lesbian, gay, bisexual, and transgender youth. 

Journal of Adolescent Health, 50(4), 353-357. 

doi:10.1016/j.jadohealth.2011.08.006 

Cochran, B., Stewart, A., Ginzler, Z., Cauce, A. 

(2002). Challenges faced by homeless sexual 

minorities: comparison of gay, lesbian, bisexual, 

and transgender homeless adolescents with their 

heterosexual counterparts. American Journal of 

Public Health. 92(5). 733-777. 

Hatzenbuehler, M. L. (2011). The social environment 

and suicide attempts in lesbian, gay, and 

bisexual youth. Pediatrics, 127(5), 896-903. 

doi::10.1542/peds.2010-3020 

Harek, G.M. (2004) Beyond homophobia: Thinking 

about sexual prejudice and stigma in the twentyfirst 

century. Sexuality Research and Social 

Policy. 1(2), 6-24. 

Horn, S., & Romeo, K. (2010). Peer contexts for 

lesbian, gay, bisexual, and transgender students: 

reducing stigma, prejudice, and discrimination. 

Prevention Researcher, 17(4), 7-10. 

Kann, L., Olsen, E.O., McManus, T., Kinchen, S., 

Chyen, D., Harris, W., Wechsler, H. (2011). Sexual 

identity, sex of sexual contacts, and health-risk 

behaviors among students in grades 9–12 — 

youth risk behavior surveillance, selected sites, 

United States, 2001–2009. Centers for Disease 

Control and Prevention Morbidity and Mortality 

Weekly Report, 60(1), 5-6. 

McAndrew, S., & Warne, T. (2012). Gay children 

and suicidality: the importance of professional 

nurturance. Issues In Mental Health Nursing, 

33(6), 348-354. doi:10.3109/01612840.2012.6568 

21 

McAndrew, S., & Warne, T. (2010). Coming 

out to talk about suicide: gay men and 

suicidality. International Journal Of Mental 

Health Nursing, 19(2), 92-101. doi:10.1111 

/j.1447-0349.2009.00644. 

Silenzio, V., Pena, J., Duberstein, P., Cerel, J., & 

Knox, K. (2007). Sexual orientation and risk 

factors for suicidal ideation and suicide attempts 

among adolescents and young adults. American 

Journal of Public Health, 97(11), 2017-2019. 

doi:10.2105/AJPH.2006.095943 

U.S. Department of Health and Human Services 

(HHS) Office of the Surgeon General and National 

Action Alliance for Suicide Prevention. 2012 

National Strategy for Suicide Prevention: Goals 

and Objectives for Action. Washington, DC: HHS, 

September 2012. 

Whitbeck, L. B., Chen, X., Hoyt, D. R., Tyler, K. 

A. & Johnson, K. D. (2004). Mental disorder, 

subsistence strategies, and victimization among 

gay, lesbian, and bisexual homeless and runaway 

adolescents. The Journal of Sex Research, 41(4). 

p.334


Complementary Treatment Options for Childhood and Adolescent 

Attention Deficit/Hyperactivity Disorder 

Devan Costelle 

Nursing Student 

University of Kentucky 


Purpose 

A diagnosis of Attention Deficit Hyperactivity 

Disorder (ADHD) can increase a child’s medical cost 

by more than a thousand dollars per year. A majority 

of this expense is due to the cost of prescription 

medications (Ray, Levine, Croen, Bokhari, Hu & 

Habel, 2006). Complementary therapies may be 

alternative symptom management strategies for 

some children with ADHD. A literature review was 

conducted using PubMed and CINAHL to evaluate 

the efficacy of pharmacologic and complementary 

alternative medicine (CAM) therapies in treating 

childhood and adolescent ADHD symptoms. Key 

words used were “attention deficit hyperactivity 

disorder, drug therapy and complementary alternative 

medicine.” Only articles in English and relevant to 

children and adolescents were reviewed. 

Problem 

Attention Deficit Hyperactivity Disorder is a 

neurodevelopmental and neurobehavioral disorder 

commonly affecting children and adolescents 

(Benner-Davis & Heaton, 2007). It is identified by the 

core symptoms of inattentiveness, hyperactivity, and 

impulsivity and can have long-term consequences 

on academic performance, social functioning, selfesteem, 

occupational function, and employment 

stability if not adequately treated (Bader & Adesman, 

2012; Chou et al., 2012). This condition affects up 

to 12% of children and adolescents in the United 

States and up to 19.8% of children and adolescents 

worldwide (Bader & Adesman, 2012; Hanwella, 

Senanayake & Silva, 2011). Treatment options focus 

on a multimodal plan that typically incorporates 

the use of pharmacologic therapy in combination 

with behavioral therapy (Hodgkins, Shaw, Coghill 

& Hechtman, 2012). The major goals of treatment 

are restoration of optimal emotional, behavioral, 

social, and academic functioning, and symptom 

management (Chou, et al., 2012). 

Traditionally, the mainstay of therapy for 

children and adolescents with ADHD has been 

pharmacologic therapy with stimulants, tricyclic 

antidepressants, norepinephrine reuptake inhibitors 

and alpha-adrenergic agonists (Hodgkins, Shaw, 

Coghill & Hechtman, 2012; Hanwella, Senanayake 

& Silva, 2011; Benner-Davis & Heaton, 2007). These 

pharmacotherapies reduce hyperactivity, inattention, 

and impulsivity while improving classroom 

disruption, antisocial behavior, self-esteem, and 

learning achievement (Hanwella, Senanayake & Silva, 

2011). Many parents have sought CAM therapies 

due to concerns about the safety of long-term 

medication use (Pellow, Solomon & Barnard, 2011). 

With the increasing demand for CAM therapies as a 

treatment option for childhood and adolescent ADHD, 

nurses should be aware of current evidence-based 

CAM therapies, such as neurofeedback, behavioral 

therapy, symptom-reduction diets, and fatty-acid 

supplementation, among others, in order to create a 

treatment plan that is both appropriate and effective. 

Evidence 

Stimulant medications are the most widely 

used and prescribed treatment for childhood and 

adolescent ADHD (Biederman et al., 2008). Children 

who take stimulant medications show the greatest 

reduction in their symptoms when compared to 

other interventions (Benner-Davis & Heaton, 2007). 

Stimulants, such as methylphenidate, work by 

blocking reuptake of dopamine and norepinephrine 

or inhibiting their metabolism, thereby decreasing 

hyperactivity and increasing attention (Benner-Davis 

& Heaton, 2007). However, stimulants fail to treat 

and control symptoms in 25–30% of children and 

adolescents with ADHD (Biederman et al., 2008). 

The most common adverse effects of stimulants are 

appetite loss, abdominal pain, sleep disturbances, 

and headaches (Pediatrics,” 2011). Stimulants are 

also associated with a risk of growth suppression, 

tics, dyskinesias and an increased likelihood of 

substance abuse (Benner-Davis & Heaton, 2007). 

When stimulants do not effectively treat ADHD or 

parents deem the side effects of these drugs too risky, 

second line drugs may be considered. Clonidine and 

guanfacine are alpha-adrenergic agonists that bind 

to alpha-receptors, particularly those in the frontal 

cortex, resulting in an increase in attention and 

organizational function (Biederman et al., 2008). 

These medications may be administered alone or in 

combination with stimulants. Antidepressants may 

be used when other drugs are ineffective although 

they are typically not prescribed unless the patient 

has comorbidities of social withdrawal and depression 

(Benner-Davis & Heaton, 2007). Atomoxetine, a 

non-stimulant medication, has comparable efficacy 

in treating childhood and adolescent ADHD 

as the stimulant methylphenidate without the 

abuse potential or adverse effects associated with 

stimulants (Hanwella, Senanayake & Silva, 2011; 

Benner-Davis & Heaton, 2007). 

Complementary Treatment Options continued on page 6 

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Complementary Treatment Options continued from page 5 

Pharmacologic therapy is often effective in treating 

childhood and adolescent ADHD but there has been 

increased interest in CAM therapies from parents 

looking for natural therapies. This interest in CAM 

is often driven by concerns about medication side 

effects and long-term pharmacologic therapy in young 

children (Bader & Adesman, 2012). Complementary 

and alternative therapies in ADHD treatment include 

neurofeedback (NF), behavioral therapy, dietary 

management and fatty acid supplementation. 

Neurofeedback involves placing electrodes on 

the scalp to record specific brain activity. Allowing 

the child to visualize his or her brain activity can 

help change the activity level into a more regulated 

pattern. Studies have shown that NF improved the 

core symptoms of ADHD in children and adolescents. 

The effects of neurofeedback on hyperactivity and 

attention were equivalent to those of stimulant drugs, 

making NF an efficacious option for parents seeking 

an alternative to pharmacologic therapies (Duric, 

Assmus, Gundersen & Elgen, 2012). While nurses 

cannot provide NF therapy, they play an essential 

role in advocating for their patients and assisting in 

developing the plan of care. Therefore, it is important 

for nurses to be aware of this treatment option. 

Behavioral therapy is a CAM treatment that is 

used either alone or as an adjunct to pharmacologic 

therapy. Behavioral therapy involves modifying 

the environment, both at home and at school, to 

provide fewer distractions and more structure 

and organization. This therapy is based on the 

concept of rewarding or disciplining for certain 

behaviors in an effort to help modify those behaviors, 

thereby decreasing the symptoms associated 

with ADHD. Initially, it can be a singular mode of 

therapy for children whose parents want to avoid 

pharmacotherapy. If behavioral therapy is not 

sufficient, concurrent interventions can be added 

to the treatment plan. Behavioral therapy should be 

implemented in combination with medications in 

adolescents, who are less likely to respond to rewards 

and punishments alone. Behavior therapy is a longterm 

process and it is often difficult to maintain. 

This type of therapy only stimulates a portion of 

the child’s natural reward system, which can make 

it less effective in some children. However, when 

implemented correctly, either alone or in combination 

with stimulant medications, behavior therapy has 

been shown to decrease the core symptoms of ADHD 

in children and adolescents (Benner-Davis & Heaton, 

2007). 

It has been suggested that the symptoms of ADHD 

may be due to a hypersensitivity to certain foods 

or additives, low protein and high carbohydrate 

diets, and mineral deficiencies. Symptom-reduction 

diets, (e.g., Feingold and Elimination), have been 

postulated as CAM therapies to treat the symptoms. 

These diets eliminate food additives and certain 

foods that cause behavioral responses from the 

diet. These diets are based on a reduced intake of 

refined carbohydrates and sugar to improve the 

core symptoms of ADHD. Excessive consumption of 

these substances can cause aggressive and restless 

behavior and can impair learning ability. Eliminating 

preservatives and artificial flavoring or coloring 

has been shown to improve the symptoms of ADHD. 

Elimination of cow’s milk, cheese, eggs, wheat cereal, 

chocolate, nuts and citrus fruits may also improve 

the symptoms of ADHD (Pellow, Solomon & Barnard, 

2011). Mineral supplementation with zinc, iron, 

calcium, magnesium, and selenium, along with the 

implementation of a more balanced diet is also a CAM 

dietary option. Although dietary change strategies 

show promise, there is no scientific consensus on the 

best dietary options for ADHD treatment in children 

and adolescents (Pellow, Solomon & Barnard, 2011). 

Children and adolescents should be monitored closely 

during dietary therapies to ensure adequate nutrition. 

Researchers have also found that deficiencies 

in essential fatty acids may cause the symptoms 

of ADHD. Supplementation to correct deficiencies 

has been effective in minimizing these symptoms 

in children and adolescents. Essential fatty acids, 

particularly omega-3 and omega-6, are vital for 

normal brain development and function. Deficiencies 

in these fatty acids delay cell growth, neural 

signaling, and gene expression, which are associated 

with an increase in the symptoms associated with 

ADHD (Bader & Adesman, 2012). Studies have 

shown that daily supplementation with 8 – 19g of 

omega-3 fish oil can help reduce anxiety, attention 

difficulties, and behavioral problems in children and 

adolescents with ADHD (Pellow, Solomon & Barnard, 

2011). As with all dietary strategies, this omega-3 

supplementation should be in conjunction with close 

monitoring by a health care provider. 

Additional CAM therapies are listed in Table 1. 

Although clinical trials of these therapies are in early 

stages, evidence indicates that these treatments 

do not worsen the symptoms of ADHD and do not 

cause any harm to adolescents and children (Bader 

& Adesman, 2012). Additional research needs to 

be conducted to understand the efficacy and to 

determine the optimum dosages of treatments, 

but these CAM therapies may be options for those 

families looking for less invasive therapies. 

Table 1. Additional complementary and alternative 

therapies for treatment of symptoms of attention 

deficit hyperactivity disorder 

Alternative 

CAM Therapy 

Exercise 

Therapy 

Homeopathic 

Treatment 

Meditation, 

Yoga, 

Massage, and 

Acupuncture 

Repetitive 

Transcranial 

Magnetic 

Stimulation 

Anthroposophic 

Therapy 

Interactive 

Metronome 

Sensory 

Integration 

Therapy 

CogMed 

Description 

Physical exercise is thought 

to decrease hyperactivity in 

children with ADHD by allowing 

them to redirect energy 

Functions on the principle 

that ‘like cures like,’ therefore 

treating ADHD with a substance 

that produces similar symptoms 

can actually help minimize the 

symptoms 

Relaxes children and 

adolescents with ADHD while 

decreasing core symptoms 

Noninvasive therapy using weak 

electrical currents to stimulate 

certain areas of the brain 

A treatment using art, exercise, 

and forms of massage therapy 

to work on the equilibrium 

between an individual’s nerve 

sense system and metaboliclimb 

system, which has been 

hypothesized to have an 

imbalance in individuals with 

ADHD 

A computer-based version of the 

traditional music metronome 

aimed at increasing attention 

span 

Devices such as weighted vests 

that may improve attention and 

decrease hyperactivity 

A computer-based program 

designed to help improve the 

‘working memory,’ which has 

been hypothesized to be less 

than optimum in people with 

ADHD 

Guideline Recommendation 

Childhood and adolescent ADHD is a chronic 

problem that can continue to impact the individual 

into adulthood if not treated effectively and 

appropriately. Single therapies may work for some 

patients, while others may require a multimodal 

treatment. Therefore, it is important for nurses to 

be aware of pharmacologic and CAM therapies for 

treatment of ADHD in order to assist in creating a 

treatment plan that is effective and specific to each 

patient. Patients and parents should be actively 

involved in the treatment plan in order to increase 

compliance and ensure the best treatment outcomes. 

The efficacy of neurofeedback is comparable to 

stimulant medications without the risks and side 

effects of long-term pharmacotherapy. It is a timeconsuming 

and expensive treatment but carries 

little to no risk. Behavioral therapy is an option 

that may be effective when used alone or in adjunct 

to medications. Dietary interventions can also 

be implemented in combination with other CAM 

therapies. Supplementation alone has not proven 

adequate in controlling the core symptoms associated 

with childhood and adolescent ADHD. However, 

dietary interventions paired with other therapies may 

prove beneficial in diminishing the core symptoms 

of ADHD in children and adolescents. While other 

CAM therapies for ADHD are in the early stages of 

research, these therapies do not add additional risks 

or worsen symptoms. They may be implemented prior 

to medication administration when the patient and 

family choose alternative therapies. Nurses are in key 

roles to assist families in making decisions related 

to these CAM therapies, which show promise in 

reducing the impact of ADHD on social and academic 

functioning and improving quality of life. 

References 

ADHD: Clinical practice guideline for the 

diagnostics, evaluation, and treatment of 

attention-deficit/hyperactivity disorder in 

children and adolescents. (2011). Pediatrics, 128 

(1007). DOI: 10.1542/peds.2011-2654 

Bader, A., & Adesman, A. (2012). Complementary 

and alternative therapies for children and 

adolescents with ADHD. Current Opinion 

in Pediatrics, 24(6), 760-769. DOI:10.1097/ 

MOP.0b013e32835a1a5f 

Benner-Davis, S., & Heaton, P. (2007). Attention 

deficit and hyperactivity disorder: Controversies 

of diagnosis and safety of pharmacological and 

nonpharmacological treatment. Current Drug 

Safety, 2(1), 33-42. 

Biederman, J., Melmed, R., Patel, A., McBurrnett, 

K., Konow, J., Lyne , A., & Scherer, N. (2008). A 

randomized, double-blind, placebo-controlled 

study of guanfacine extended release in 

children and adolescents with attention-deficit/ 

hyperactivity disorder. Pediatrics, 121(1), 73-84. 

DOI: 1542/peds.2006-3695. 

Chou, W., Chen, S., Chen, Y., Liang, H., Lin, C., Tang, 

C.,…Hsu, J. (2012). Remission in children and 

adolescents diagnosed with attention-deficit/ 

hyperactivity disorder via an effective and 

tolerable titration scheme for osmotic release 

oral system methylphenidate. Journal of Child 

and Adolescent Psychopharmacology, 22(3), 215- 

225. DOI:10.1089/cap.2011.0006 

Duric, N., Assmus, J., Gundersen, D., & Elgen, 

I. (2012). Neurofeedback for the treatment 

of children and adolescents with ADHD: A 

randomized and controlled clinical trial using 

parental reports. BMC Psychiatry, 12(107), DOI: 

10.1186/1471244X-12-107 

Hanwella, R., Senanayake, M., & Silva, V. (2011). 

Comparative efficacy and acceptability of 

methylphenidate and atomoxetine in treatment 

of attention deficit hyperactivity disorder in 

children and adolescents: A meta-analysis. BMC 

Psychiatry, 11(176). DOI: 10.1186/1471-244X-11- 

176. 

Hodgkins, P., Shaw, M., Coghill, D., & Hechtman, 

L. (2012). Amfetamine and methylphenidate 

medications for attention-deficit/hyperactivity 

disorder: Complementary treatment options. 

(2012). European Child and Adolescent 

Psychiatry, 21, 477-492. DOI: 10.1007/s00787- 

012-0286-5 

Pellow, J., Solomon, E., & Barnard, C. N. (n.d.). 

Complementary and alternative medical 

therapies for children with attention-deficit/ 

hyperactivity disorder. (2011). Alternative 

Medicine Review, 16(4), 323-337. 

Ray, G. T., Levine, P., Croen, L. A., Bokhari, F., 

Hu, T., & Habel, L. A. (2006). Attention deficit/ 

hyperactivity disorder in children: Excess 

costs before and after initial diagnosis and 

treatment cost differences by ethnicity. JAMA 

Pediatrics, 160(10), 1063-1069. DOI:1001/ 

archpedi.160.10.1063


Appreciative Inquiry: An Emerging Approach To Delivering Quality Nursing Care 

Joy Coles, BS 

Second Degree BSN Student 

University of Kentucky College of Nursing 


Acknowledgement 

I would like to acknowledge Dr. Deborah Reed, 

PhD, RN, FAAOHN, my Nurse Research mentor at the 

University Of Kentucky College Of Nursing, who was 

instrumental in providing this opportunity as well 

as guidance and encouragement in pursing Nursing 

Research. 

Appreciative Inquiry 

Care of persons with acute and chronic illnesses 

has become more complex, and a higher level of 

quality care is required for positive patient outcomes. 

Therefore, leadership by nursing professionals 

and implementation of evidenced-based practice 

are essential components in addressing the 

complexities of healthcare delivery and improving 

patient outcomes. Appreciative Inquiry (AI) is a 

leadership skill that brings the best experiences 

of each individual through discovery, design, and 

pursuit of goal achievement in an effort to make 

“the best of what is” better (Moore, 2007). AI is a 

non-traditional method and philosophical principle 

that focuses on what is working well. It is designed 

to drive individual and organizational improvement. 

The purpose of this paper is to highlight the use of 

Appreciative Inquiry and its potential implications 

on positive patient outcomes when used in evidencebased 

clinical practice. 

Background: What is Appreciative Inquiry? 

In the early 1980’s, Appreciative Inquiry was 

spearheaded by two pioneers, David Cooperrider and 

Suresh Srivastva, professors at the Weatherhead 

School of Management at Case Western Reserve 

University. According to the Center for Appreciative 

Inquiry (2013), many organizations are now using 

AI in an effort to implement positive changes and 

improvement based on five original core principles: 

constructionist, simultaneity, anticipatory, poetic, 

and positive. The constructionist principle focuses 

on language and conversation and how words shape 

the world. The simultaneity principle highlights 

the notion that merely asking a question denotes 

change. The poetic principle indicates that the 

choice of what to study and learn in regard to the 

organization will affect what will be created. The 

anticipatory principle describes the hopeful image 

of the future and how it will determine a more 

positive present day. Finally, the positive principle 

generates momentum through positive questions. 

AI implements these positive core principles by the 

5-D cycle; Definition, Discovery, Dream, Design 

and Destiny/Delivery (Mohr, B. J. & J. M. Watkins, 

2002), as described in the figure below: 

Figure 1. The 5-D Cycle of Appreciative Inquiry 

Adapted from Mohr, B. J. & J. M. Watkins, The 

Essentials of Appreciative Inquiry: A Roadmap for 

Creating Positive Futures,Waltham, MA: Pegasus 

Communications, Inc., 2002. 

Attitudes within the healthcare organization 

affect patient care and outcomes. Thus, positive 

individual and organizational change or 

enhancement could mean better care for the patient. 

Effective communication, respect and competency 

are fundamental to delivering quality patient care. In 

order to have better quality and improved outcomes 

there is a dependency upon cohesiveness among the 

health care team. Unlike the traditional problem 

solving approach of focusing on what is not working, 

Appreciative Inquiry focuses on what is currently 

working well and how to do more of what has had 

a positive effect on team interaction to enhance 

quality care. Table 1 briefly compares the traditional 

problem-solving approach in comparison to (AI): 

Traditional Approach 

Identify problem 

Focus on what needs to 

be fixed 

Focus on weaknesses 

Lists negatives “what we 

don’t want” 

Analyze solutions 

Appreciative Inquiry 

Identify what is working 

well 

Inspire to do more of 

what is working 

Focuses on strengths 

Lists positives “what we 

want to see” 

Create or co-construct 

the dream/vision 

Appreciative Inquiry in practice: 

Conversational dialogue that revolves 

around success or the positive is engaging and 

transformational in and of itself. Havens, Wood, 

and Leeman (2006) conducted a research project 

in which AI was implemented as a methodology for 

positive organizational change in order to improve 

communication and nursing involvement in decision 

making. They noted that the aim of AI is to identify 

what is working well, and that once adopted, 

healthcare team members providing patient care 

increasingly respond with a “positive, rather than 

a problem-oriented approach” (Havens et. al, 2006). 

Nursing leadership and involvement in decisions 

with the healthcare team regarding patient care was 

associated with high quality care in this innovative 

study. 

AI sets the stage for healthcare teams to 

collaborate effectively by utilizing a strength based 

approach that encourages and enables healthcare 

team members to focus on the positives. For 

example, nurses at the University of Manitoba 

utilizing the current Situation, Background, 

Assessment and Recommendation (SBAR) handoff 

protocol noted current practices that were working 

well (Clarke, 2012). Focusing on the positives 

enabled the healthcare team to understand how 

they fit individually into the bigger picture of quality 

patient care. 

Dr. Karen Stefaniek, PhD, RN, certified in 

Appreciative Inquiry by the Corporation for Positive 

Change, stated “in every organization something 

is working well” and “asking positive questions or 

Appreciative Inquiry is a leadership strategy that can 

be used at the bedside” (personal communication, 

October 14, 2013). Quality care is the responsibility 

of all collaborating members of the healthcare team 

within an organization. The core principles of (AI) 

build on individual and organizational strengths 

and highlights what successful practices need to 

be preserved in order to improve quality care and 

patient outcomes. 

Conclusion 

Organizations often struggle with the concept of 

focusing on the positive. Traditional methodologies 

of problem-solving highlight what is not working and 

what needs to be fixed. However, AI amplifies the 

positives and reviews what is working well both for 

the organization and the respective team members. 

Therefore, AI is a strategic method for relinquishing 

and maintaining positive organizational change 

(Havens et. al, 2006). With AI as a centralized theme 

for any organization or healthcare team, focusing on 

the positive brings a new and fresh paradigm that 

inspires confidence, effectiveness and cohesiveness. 

Nurses and other healthcare team members use AI 

as an unconventional approach to celebrate all that 

is good with the organization and the team and 

use those positives as building blocks to create and 

maintain positive patient outcomes. As AI gains 

credibility and exposure we may see the migration of 

critical analysis move closer to a positive approach 

to improvement in organizational systems, nursing 

practice, and patient outcomes. 

References 

Clarke, D., Werestiuk, K., Schoffner, A., Gerard, 

J., Swan, K., Jackson, B., & …Probizanski, 

S. (2012). Achieving the “perfect handoff” in 

patient transfers: Building teamwork and trust. 

Journal of Nursing Management, 20(5), 592-598. 

doi:10.1111/j.1365-2834.2012.01400.x 

Havens, D. S., Wood, S. O., & Leeman, J. (2006). 

Improving nursing practice and patient care: 

Building capacity with appreciative inquiry. 

Journal of Nursing Administration, 36(10), 463-470. 

Marchionni, C., & Richer, M. (2007). Using 

appreciative inquiry to promote evidence-based 

practice in nursing: the glass is more than half 

full. Canadian Journal of Nursing Leadership, 

20(3), 86-97. 

Mohr, B. J. & J. M. Watkins, The Essentials of 

Appreciative Inquiry: A Roadmap for Creating 

Positive Futures, Waltham, MA: Pegasus 

Communications, Inc., 2002. 

Moore, S., & Charvat, J. (2007). Promoting health 

behavior change using appreciative inquiry: moving 

from deficit models to affirmation models of care. 

Family & Community Health. 30(1S), S64-74. 

Richer, M., Ritchie, J., & Marichionni, C. (2009). “If 

we can’t do more, let’s do it differently!”: using 

appreciative inquiry to promote innovative 

ideas for better health care work environments. 

Journal of Nursing Management, 17(8), 947 – 955. 

DOI: 10.1111/j.1365-2834.2009.01022.x 

Shendell-Falik, N., Feinson, M., & Mohr, B. J. (2007). 

Enhancing patient safety: improving the patient 

handoff process through appreciative inquiry. 

Journal of nursing administration, 37(2), 95-104. 

The Center for Appreciative Inquiry. Las 

Vegas, NV. Retrieved from: http:// 

centerforappreciativeinquiry.net/more-on-ai/thegeneric-processes-of-appreciative-inquiry/ 

We have a long history of representing nursing professionals who are 

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Personal Experience 

I Do Make a Difference 

Rita Varnell, RN 

Surgical Services 

Kosair Children’s Hospital 

Louisville, Kentucky 

Being an operating room nurse is quite different 

than other nursing departments. I have not always 

been an OR nurse so I have a perspective that is 

somewhat unique. As an OR nurse, we do much of 

our work when our patients are asleep. We set up the 

room, get all the right equipment, and gather all the 

supplies needed for the surgery. When I became an 

OR nurse I did not realize I would also have to serve 

as a mechanic, an engineer, environmental services, 

data & IT technician, and first and foremost—a 

patient advocate. 

When all of our “stuff” is in order, we head to the 

pre-op area to interview our patient and their family. 

We ensure all documentation is in order and we get 

handoff report from the pre-op nurse. We introduce 

ourselves to the patient and family and discuss the 

surgery and talk about what they can expect and we 

involve our patients in all of this discussion. This is 

our very brief window of time to make a difference, 

make an impact, and settle their fears and anxiety. 

Once the surgical procedure is complete, we prepare 

the patient to go to recovery room. We clean & warm 

the patient up and get them ready for transport to 

the appropriate area and then we are off to the next 

case. In our daily grind, it is easy to feel sometimes 

like the unsung hero. Patients rarely remember us 

like they do their nurse on the floor and we wonder 

some days whether we make a difference and 

are doing the nursing care we set out to do when 

choosing this profession. I rarely hear the outcomes 

of our patients unless I get the chance to visit 

them on the floors, which I have done in the past. 

However, it became remarkably clear to me that we 

still DO make a difference when I got this card in the 

mail in April of 2013 from a patient I had cared for 

two years earlier! The card read: 

“Thank you so much for being one of those 

wonderful people. I know this is a very belated show 

of our gratitude, and I immensely apologize for that. 

We just want to thank you for going above and 

beyond for us. The support and comfort you offered 

were a true blessing in an uncertain time. You are so 

awesome, and I wanted to tell you that. Thank you 

from the bottom of our hearts for being a help to us. 

God Bless You and Yours” 

This is certainly a sentiment I don’t hear 

every day as an OR nurse. I remembered that 

case and that patient well. It was an emergency 

for a spontaneous pneumothorax. When the 

patient arrived in the pre-op area she was very 

uncomfortable and I could tell she was really scared. 

I tried to comfort and reassure her and her family. 

I was, as I always am, by her side when she went 

to sleep. Then I went about assisting anesthesia 

providers to put in IV lines and intubate her, 

positioning her for the surgery and padding lines 

and bony prominences. During the surgery, I kept an 

eye on the temperature of the patient, documented 

and counted instruments and sponges, and assisted 

the anesthesiologist throughout the case with blood, 

IV fluids, medications, labs, etc. I also kept the 

family informed throughout the procedure. 

I happened to have the opportunity to care for 

this young lady once more after this initial surgery. 

Maybe that is why she remembered me; but I will 

remember her because she made me realize I do 

make a difference in the profession I still love, even 

though I may have limited patient contact and serve 

as a liaison for the family. Now I know I make a 

difference. 

Start your future 

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The Road to Legislative Mandate of 

HPV Vaccination in Kentucky 

Gina L. Purdue, DNP, RN 

Eastern Kentucky University 

Richmond, Kentucky 

According to the Centers for Disease Control ([CDC], 2013c), approximately 79 

million Americans are currently infected with human papillomavirus (HPV), a 

sexually transmitted virus. In addition, approximately 14 million people become 

newly infected each year. Nearly all sexually active men and women become 

infected at some point in their lives (CDC, 2013c). HPV is the most common 

sexually transmitted infection and has also been implicated in numerous 

cancers (CDC, 2013c). Cervical cancer, which affects 12,000 women in the U.S. 

annually, is the most common HPV-associated cancer (CDC, 2013a). Kentucky 

has one of the highest prevalence and mortality rates of cervical cancer in the 

country (CDC, 2013b). HPV-associated cancer is not only a risk for females, 

but males as well. Nearly 9,000 men in the U.S. are affected by HPV-associated 

cancers each year (CDC, 2013c). Overall, approximately 21,000 cancers 

annually are potentially preventable by HPV vaccines (CDC, 2013c). The HPV 

vaccine was approved by the Food and Drug Administration (FDA) for use in 

females in June 2006, in males for genital warts in October 2009, and extended 

for the prevention of anal cancer in both males and females in December 2010 

(Dunneetal., 2011). The HPV vaccine has been recommended by the CDC (2013d) 

for females ages 11 to 26 and males ages 11 to 21. 

As a result of the FDA vaccination approvals and the alarming implications 

of HPV, most states and Washington D.C. have introduced legislation to support 

the use of the HPV vaccine (National Conference of State Legislatures [NCSL], 

2013). Legislation mandating vaccination for adolescents has been overall 

unsuccessful. HPV legislation has been a sensitive issue and is surrounded 

by high levels of controversy. Successful legislation has focused primarily 

on insurance coverage, research, and education. Kentucky had years of 

unsuccessful attempts before finally enacting mandatory HPV vaccination 

legislation in 2013. 

History of HPV Legislation in Kentucky 

Kentucky policy makers introduced four bills in the legislative session 

following the release of the HPV vaccine. House Bill 143 (2007) proposed to 

mandate vaccination for female middle school students. House Bill 345 (2007) 

proposed the same, but allowed parental exemption for any reason. House 

Bill 327 (2007) appropriated $4,116,000 from the general fund to provide 

voluntary HPV vaccination to uninsured females ages 9 to 26. All three bills 

remained unenacted at the end of the 2007 session. Dekker (2008) noted several 

factors that inhibited the passage of legislation in Kentucky during the 2007 

session: technical infeasibility, lack of value acceptability, and a negative state 

mood. The fourth bill, Senate Bill 98 (2007), primarily addressed dentists 

but had an amendment tacked on it to provide Medicaid coverage for HPV 

vaccination for enrollees ages 9 to 26. This bill passed legislation unopposed. 

In the following years,legislators introduced bills attempting to mandate HPV 

vaccination with no success. A different approach to legislation was even taken 

in 2012 with House Resolution 80. A resolution differs from a bill in that it is 

a recommendation without the force of law (Kentucky Legislature, ND). House 

Resolution 80 (2012) urged, not mandated, parents to have their daughters 

and sons vaccinated with the HPV vaccine, adult females and males through 

age 26 to have the HPV vaccination, and all citizens of the Commonwealth of 

Kentucky to become more knowledgeable of the benefits of the HPV vaccination. 

House Resolution 80, like previous legislation, failed to pass. Successful passage 

of HPV legislation in Kentucky finally came in 2013 with the enactment of 

Senate Bill 52. Senate Bill 52 began as a bill requiring electronic filing of death 

certificates. Democratic Representative Watkins, who had sponsored multiple 

HPV attempts in the past, attached an amendment that would require HPV 

immunization prior to entry into the sixth grade with the option for parents to 

opt out for any reason (S.B.52, 2013). Senate Bill 52 passed 92-1. 

Outside of the policy arena, public view on HPV vaccination in Kentucky 

has varied. A study by Christian, Christian, and Hopenhayn (2009) found 

that 57.6% of Kentucky women had heard of HPV and 70.2% accepted the 

vaccination for girls. A survey by Dekker (2008) noted that 47% of Kentucky 

adults opposed the HPV vaccine mandate for middle school girls and 38% 

supported the mandate. Nationally, the debate on HPV vaccination has been 

heated for years. 

Review of the Debate 

Haber, Malow, and Zimet (2007) noted numerous controversies surrounding 

HPV vaccination included such things as intrusion of parenteral autonomy, 

feelings that vaccination which prevents non-casually transmitted disease 

should not be mandated, limited health care dollars available, potential cost 

concerns and supply issues, legislation implies consent for sexual activity, 

vaccination provides false sense of protection from sexually transmitted 

diseases, long term side effects of the vaccine and its duration which are 

unknown, and that there are already too many vaccinations for children. 

Prior to the vaccination being approved for use in males, many felt that it 

was discrimination to mandate the vaccination for only girls and, therefore, a 

possible violation of Title IX of the Education Amendments of 1972 (Cook, 2008). 

Another factor leading the HPV controversy was the Texas scandal in the early 

days of the HPV legislation. Texas Governor Rick Perry filed Executive Order 

RP65 mandating vaccination for all female children prior to the admission to 

the sixth grade (NCSL, 2013). In response, riled Texas legislators passed their 

own bill overriding the executive mandate (NCSL, 2013). In addition, Governor 

Perry was found to have received financial gain from Merck, the drug company 

manufacturing Gardasil, an HPV vaccine (Weigel, 2011). The Texas scandal 

resurfaced when Governor Perry became a presidential candidate in 2011, 

once again drawing negative attention to HPV policy. Knox (2011) reported 

that Perry’s political opponent, Republican presidential candidate Michele 

Bachmann, was against .”..innocent little 12 year old girls” being “forced to have 

a government injection.” Rumors swirled about a possible financial ploy among 

drug companies and lack of safety of the vaccine (Knox, 2011). 

Among the biggest proponents of the HPV vaccine is the CDC. The CDC 

(2013d) has included the HPV vaccine for both males and females in the 

recommended vaccination schedule as developed by the Advisory Committee on 

Immunization Practices (ACIP). According to the CDC (2012) vaccinations have 

been studied in thousands of people around the world with no serious safety 

concerns. The American Academy of Pediatrics (2013) has supported the ACIP 

recommendations. Dr. Harrell Chesson (2011) of the CDC recently reported on 

the cost-effectiveness of the HPV vaccine. He discussed cost-effectiveness in the 

terms of Quality-Adjusted Life Year (QALY), which accounts for both quality and 

length of life. One year in perfect health is considered to be one QALY. According 

to Chesson, if the HPV vaccine is administered to 12 year old girls, the cost per 

QALY gained is $3,000 - $45,000. This cost range is denoted as cost-effective. 

HPV Vaccination in Kentucky continued on page 10

HPV Vaccination in Kentucky continued from page 9 

The cost-effectiveness of the vaccine for adult 

females and males is more uncertain. For example, 

vaccinating males is less cost-efficient if female 

vaccination rates are high. The cost of vaccination 

is approximately $400 for a series of 3 vaccinations 

administered over 6 months (CDC, 2012). 

Impact of the HPV Controversy 

Though most policy has not been powerful 

enough to mandate HPV vaccination, the policy 

process itself has been very powerful. This power is 

evident in the 46 million doses of the HPV vaccine 

that have been distributed in the United States 

as of June 2012 (CDC, 2012). A study of seven 

Appalachian states revealed that Kentucky had the 

greatest number of doses of HPV vaccine provided 

per month per health department (mean=22.5, 

SD=38.3) in its 51 Appalachian counties compared 

with Appalachian counties in other states (Katz et 

al, 2009). In addition, recent studies have shown 

a decrease in vaccine-type HPV in U.S. teens since 

the introduction of the vaccination (CDC, 2013e), a 

decrease in the prevalence of oral HPV prevalence 

in vaccinated women (Herrero et al., 2013), and 

a reduction in female and male HPV-related 

carcinomas and genital warts in the presence of 

vaccination of both males and females verses femaleonly 

vaccination (Malty, Roze, Bresse, Largeron, 

& Smith-Palmer, 2013). National attention to HPV 

has improved public awareness and encouraged 

communication within families and between 

patients and health care providers, both of which 

are essential in ensuring both parents and young 

adults have the opportunity to make informed 

decisions. A study by Roberts, Gerrard, Reimer, 

and Gibbons (2010) found that mother-daughter 

communication about sex and mother’s approval 

of HPV vaccination were positively correlated with 

vaccination status. In addition, a study by Reiter, 

Katz, and Paskett (2013) found that vaccination 

outcomes were higher among Appalachian 

females whose parents had a received a provider 

recommendation to vaccinate. Parents who chose not 

to vaccinate their children cited the primary reasons 

as the vaccination was unnecessary and a lack of 

knowledge. 

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Summary 

HPV vaccination is a national issue relevant 

to health promotion and cancer prevention. 

Policy mandating vaccination has been mostly 

unsuccessful, but success has been achieved 

through improved public awareness and 

communication nationwide. Kentucky has had 

successes in HPV legislation; however, continued 

advocacy is needed to support parents, encourage 

young adults, and support the endeavors of other 

state policy makers. 

References 

American Academy of Pediatrics. (2013). 

Recommended childhood and adolescent 

immunization-United States, 2013. Retrieved 

from http://pediatrics.aappublications.org/ 

content/131/2/397.full 

Centers for Disease Control, (2013a). Cervical cancer. 

Retrieved from http://www.cdc.gov/cancer/ 

cervical/ 

Centers for Disease Control (2013b). Cervical cancer 

rates by state. Retrieved from http://www.cdc. 

gov/cancer/cervical/statistics/state.htm 

Centers for Disease Control. (2013c). Genital HIV 

infection-Fact sheet. Retrieved from http://www. 

cdc.gov/std/HPV/STDFact-HPV.htm 

Centers for Disease Control (2013d). HPV also known 

as human papillomavirus. Retrieved from http:// 

www.cdc.gov/vaccines/vpd-vac/hpv/downloads/ 

dis-HPV-color-office.pdf 

Centers for Disease Control (2013e). Press release: 

New study shows HPV vaccine helping lower HPV 

infection rates in teen girls. Retrieved from http:// 

www.cdc.gov/media/releases/2013/p0619-hpvvaccinations.html 

Centers for Disease Control, (2012). HPV vaccine 

information for young women - Fact Sheet. 

Retrieved from http://www.cdc.gov/stdfact-hpvvaccine-young-women.htm 

Chesson, D. (2011). HPV vaccine cost-effectiveness 

updates and review. Retrieved from http://www. 

cdc.gov 

Christian, W.J., Christian, A., & Hopenhayn, 

C. (2009). Acceptance of the HPV vaccine 

for adolescent girls: Analysis of stateadded 

questions from the BRFSS. Journal of 

Adolescent Health, 44, 437-445. doi:10.1016/j. 

jadohealth.2008.09.00l 

Cook, K. (2008). Ethical and legal issues 

accompanying legislation requiring HPV 

vaccination of girls. Health Matrix: Journal of 

Law Medicine, 18, 209-228. 

Dekker, R.L. (2008). Human papillomavirus vaccine 

legislation in Kentucky: A policy analysis. 

Policy, Politics, & Nursing Practice, 9, 40-49. 

doi:10.1177/1527154408317851 

Dunne, E.F., Markowitz, L.E., Chesson, H., Curtis, 

C.R., Saraiya, M., Gee, J., & Unger, E.R. (2011). 

Recommendations on the use of quadrivalent 

human papillomavirus vaccine in males- 

Advisory committee on immunization practices 


Calendar Of Events 2014 

 

(ACIP), 2011. Morbidity and Mortality Weekly 

Report, 60(50), 1705-1708. 

Haber, G., Malow, R.M.,& Zimet, G.D. (2007). The 

HPV vaccine mandate controversy. Journal of 

Pediatric and Adolescent Gynecology, 20, 325- 

331. doi:10.1016/j.jpag.2007.03.101 

Herrero, R., Quint, W., Hildesheim, A, Gonzalez, 

P., Struijk, L., Katki, H.A,... Kreimer, AR. 

(2013). Reduced prevalence of oral human 

papillomavirus (HPV) 4 years after bivalent HPV 

vaccination in a randomized clinical trial in 

Costa Rica. PLoS One, 8(7), e68329. doi:10.1371/ 

journal.pone.0068329 

H.B. 143, 07RS Kentucky General Assembly (2007). 

H.B. 327. 07RS Kentucky General Assembly (2007). 

H.B. 345, 07RS Kentucky General Assembly (2007). 

H.R. 80, 12RS Kentucky General Assembly (2012). 

Katz, M.T., Kluhsman, B.C., Kennedy, S., Dwyer, 

S., Schoenberg, N., Johnson, A.,... Dignan, M. 

(2009). Human papillomavirus (HPV) vaccine 

availability, recommendations, cost, and 

policies among health departments in seven 

Appalachian states. NIH-PA Author Manuscript, 

1-14. 

Kentucky Legislature. (ND). Glossary of Legislative 

Terms. Retrieved from http://www.lrc.ky.gov/ 

legproc/glossary.htm 

Knox, R. (2011, September 19). HPV vaccine: The 

science behind the controversy. Retrieved from 

http://www.npr.org/2011/09/19/140543977/ 

hpv-vaccine-the-science-behind-the-controversy 

Marty, R., Roze, S., Bresse, X., Largeron, N., & 

Smith-Palmer, J. (2013). Estimating the clinical 

benefits of vaccinating boys and girls against 

HIV-related diseases in Europe. BMG Cancer, 

13(10), 1-12. doi:http//www.biomedcentral. 

com/1471-2407/13/10 

McRee, A.L., Reiter, P.L., Gottlieb, S.L., & Brewer, 

N.T. (2011). Mother-daughter communication 

about HPV vaccine. Journal of Adolescent Health, 

48, 314-317. 

National Conference of State Legislatures. (2013). 

HIV vaccine. Retrieved from http://www.ncsl. 

org/issues-research/health/hpv-vaccine-statelegislation-and-statutes 

Reiter, P.L., Katz, M.L.,& Paskett, E.D. (2013). 

Correlates of HPV vaccination among adolescent 

females from Appalachia and reasons why their 

parents do not intend to vaccinate. Vaccine, 

31, 3121-3125. doi: http://dx.doi.org/10.l016/j. 

vaccine.2013.04.068 

Roberts, M.E., Gerrard, M., Reimer, R., & Gibbons, 

F.X. (2010). Mother-daughter communication 

and human papilloma virus uptake by college 

students. Pediatrics, 125(5), 982-989. 

S.B. 52, 12RS Kentucky General Assembly (2013). 

S.B. 98, 07RS Kentucky General Assembly (2007). 

Weigel, D. (2011, September 13). How Rick Perry 

can defuse the controversy over the HPV 

vaccine. Slate Magazine. Retrieved from http:// 

www.slate.com/articles/news and politics/ 

politics/2011/09/political inoculation.html 

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January 2014 

1 New Year’s Day - KNA Office Closed 

13 10:00 AM KNA Board of Directors 

Conference Call 

20 Martin Luther King, Jr. Holiday – 

KNA Office Closed 

February 2014 

7 KNA Board of Directors Leadership Retreat, 

My Old Kentucky Home State Park, 

501 E. Stephen Foster Avenue, 

Bardstown, KY 40004 

17 President’s Day Holiday – KNA Office Closed 

28 Surviving Your First Year: 

Non-Clinical Professional Issues 

Carroll Knicely Conference Center, 

2355 Nashville Road, Bowling Green, KY 42104 

April 2014 

11 Surviving Your First Year: Clinical Issues 

Carroll Knicely Conference Center, 

2355 Nashville Road, Bowling Green, KY 42104 

May 2014 

26 Memorial Day Holiday – KNA Office Closed 

July 2014 

4 Fourth of July Holiday – KNA Office Closed 

September 2014 

Labor Day Holiday – KNA Office Closed 

October 2014 

8–10 Convention 2014, Holiday Inn Hurstbourne, 

1325 South Hurstbourne, Louisville, KY 

November 2014 

11 Veterans Day - KNA Office Closed 

27-28 Thanksgiving Holiday - KNA Office Closed 

December 2014 

22-31 Christmas Holiday – KNA Office Closed 

January 2015 

1-2 New Year’s Day Holiday - KNA Office Closed 

*All members are invited to attend KNA Board of 

Directors meetings (please call KNA first to assure 

seating, meeting location, time and date)

Access to Healthcare: 

Removing Barriers for the APRN 

 

Sharon Edwards, DNP, APRN 

Eastern Kentucky University Richmond, Kentucky 

Access to Care 

Within the health care system there is a need to provide quality care that is 

accessible for all individuals. Accessibility issues include such things as health 

care located in areas where patients live and can afford. Accessibility to care 

also includes access to healthcare providers who have the ability to provide 

management of medication and treatment regimens with the understanding of 

the local culture. 

The American Nurses Association (ANA) (2004) identified the scope of practice 

for Nurse Practitioners to include the provision of treatment and prescription of 

medications. Prescriptive authority for Advanced Practice Registered Nurses 

(APRN) has been authorized for non-scheduled medication for over 15 years and 

prescriptive authority for scheduled medications since 2006 as reported by the 

Kentucky Coalition of Nurse Practitioners and Nurse Midwives (KCNPNM, 2011, p. 

2). 

The KCNPNM (2011) identified that nurse practitioners have provided care 

over 40 years and nurse midwives for over 80 years in rural counties designated 

as Health Provider Shortage Areas (HPSA). “Nurse Practitioners are practicing 

in 75 of the 81 HPSAs” (KCNPNM, 2011, p. 2). These data support the need for 

affordable and accessible healthcare in Kentucky. 

Street & Cossman (2010) reported that physicians working with APRNs 

had a more positive perception about the APRN’s practice. However, these 

same physicians did not support independent practice by the APRN but the 

“supervisory” role of the physician for the APRN. Agosta (2009) found that patient 

satisfaction of primary health care services indicated a preference for the APRN 

in perceived health education from APRNs, physicians, or physician assistants. 

The utilization of education as a preventive measure can support compliance 

with recommendations, return follow-up visits, and improved health outcomes. 

Bauer (2010) further supported the use of APRN by relating that” ....all evidence 

supports using nurse practitioners as one of the most cost-effective and feasible 

reforms to solve America’s serious problems of cost, quality, and access in health 

care” (p.231). 

Background and Significance of Access to Care 

A senate bill was introduced in January 2013 with the purpose of removing 

barriers (e.g., collaborative agreements) for APRNs providing care in areas 

where there is usually limited access to health care, due to limited numbers of 

providers. The bill recognized the scope of practice of the APRN as an independent 

practitioner and insured full legislative support to practice independently. 

Maylone et al. (2011) investigated the perceptions of nurse practitioners about 

collaboration with physicians and their level of autonomy. In the study, nurse 

practitioners perceived “increased autonomy was essential for them to use their 

skills to improve health and overall quality of life for their patients” (Maylone et 

al., 2011, p. 52). 

In many areas the requirement for a written collaborative agreement between 

the practitioner and the physician has created financial and management 

difficulties. One difficulty is the perception of the requirement for a collaborative 

physician to “supervise” the APRN (KBN, 2012b). Physicians often refer to another 

physician who specialized in a specific area without a written agreement (and fee) 

but requires APRN to have and pay for a collaborative agreement. 

It is within the scope of practice for an APRN to assess, diagnose, and treat 

individuals, including the prescription of medication (KBN, 2012b). Supporting 

the abilities of the APRN for prescription of medications, the ANA (2004) identified 

the full scope of practice for APRNs to include the prescription of medications (p. 

16) and does not require this activity to be under the supervision of a physician. 

Certification of the APRN to meet the requirements for independent practice is 

provided by national agencies through evaluation of the educational program 

(including clinical hours) and passage of a national exam. The KCNPNM (2012) 

identified 20 of 23 insurance companies credentialed APRNs as providers (not 

requiring physician collaboration) with reimbursement rate ranges of 70-100%. 

Historically, a Concurrent Resolution (a panel of two physicians, a pharmacist, 

and APRNs) was approved to study the feasibility of APRN prescription of 

scheduled medications in April, 2004. There was much discussion about possible 

solutions; however, each meeting resulted in the denial of prescribe ability of 

controlled medications for the APRNs. In 2006, Senate Bill 65 gave the Nurse 

Practitioner the right to prescribe scheduled medications with the requirement of 

a written (collaborative) agreement with a physician (Kentucky Legislature, 2006). 

Improving access to healthcare requires legislative action. Influencing political 

change is a complex process and requires knowledge of that process. Birkland 

(2011) defined politics as .”.. the process by which society determines who gets 

what, when they get it, and how they get it” (p.6). In this process there are several 

avenues that individuals can influence legislation. One method of influencing 

legislative changeis education of legislators to encourage passage of a bill. A 

second method is the use of a coalition which is a group that supports common 

basic values and core beliefs. 

While many nurses perceive one of their roles as patient advocates, they may 

have had limited participation in political matters for a variety of reasons; some 

of these reasons were identified in a study by Vandenhouten, Malakar, Kubsch, 

Block, & Gallagher-Lepak (2011). Factors included such things as a perception 

that they could make little difference on the issues and lack of time and money 

for involvement (Vandenhouten et.al., 2011). The use of a coalition concept/ 

framework provides nurses the ability to be involved in political issues without 

individually taxing them for time or money. The passage of the Affordable Health 

Care Act (AHCA), passed on the federal level, highlights the need of health care 

providers in many of the rural areas and the lack of accessibility to health care 

for individuals with either limited finances or the ability to travel. Kaiser Family 

Foundation (2011) related the AHCA as a health reform law that focuses on: (a) 

expanded coverage (available and accessible), (b) control of health care costs (use 

of various providers), and (c) an improved health care delivery system (quality and 

accessible). 

Implications for Social Justice 

With the shortage of available physicians, limitation to the delivery of quality 

health care is evident. A report from the Kentucky Board of Nursing (2012a) 

identified the total number of APRNs in the state to be 3506; of the 120 counties 

in Kentucky, there were 50 counties that identified the number of APRNs to be 

in single digits (under 10). KCNPNM (2011) reported that APRNs practice in 75 of 

the 81 HPSAs. With both the limited number of primary care physicians and the 

low number of APRN in many counties, the access to quality care is significantly 

limited and creates a social injustice for the individuals living in those counties. 

APRN have demonstrated their willingness to provide health care to 

individuals in underserved areas, removing barriers to health care such as 

availability and limited transportation. The social justice includes provision of 

quality, equable, accessible care for all individuals regardless of their location or 

insurance coverage or lack thereof. The goal of APRN is to provide quality care 

for individuals with limited access. The involvement of APRN include providing 

education to the legislators. Through education nurses can show the autonomy 

of the APRN practice, share the impact of such care on the clients (the legislator’s 

constituent), and meet the needs which will only increase with the Affordable 

Health Care Act. 

Summary 

As nurses face changes in the healthcare arena, we must be aware and 

involved in the legislation that affects our delivery of care to our clients. While 

many do not perceive their ability to influence legislative matters, there are things 

we can do. Such endeavors can include inviting legislators to APRN’s practice, 

encouraging clients to talk with their legislators, and share evidence-based 

information on the outcomes of APRN practice. Nursing is a strong profession and 

has faced many challenges in the past. Nursing now needs to advocate for our 

profession and thus provide a positive impact on the healthcare of the clients. 

References 

Agosta, L. J. (2009). Patient satisfaction with nurse practitioner-delivered primary 

healthcare services. American Academy of Nurse Practitioners, 21, 610-617. 

doi:10.l111/j.l745- 7599.2009.00449.x 

American Nurses Association, (2004). Nursing: Scope and standards of practice. 

Washington, D. C.: author. 

Bauer, J.C. (2010). Nurse practitioners as an underutilized resource for 

health reform: Evidenced-based demonstrations of cost-effectiveness. 

American Academy of Nurse Practitioner, 22,228-231. doi: 10.1111/j.l745- 

7599.20l0.00498.x 

Birkland, T.A.(2011). An introduction to the policy process. New York: M.E. Sharpe. 

Kaiser Family Foundation. (2011). Focus on health reform: Summary of new health 

reform law. Washington, D. C.: Kaiser Family Foundation. Retrieved from 

www.kff.org 

Kentucky Board of Nursing (KBN). (2012a). Current APRN licenses by county of 

residence. Retrieved from www.kbn.ky.org. 

Kentucky Board of Nursing (KBN). (2012b). APRN prescriptive authority for 

nonscheduled legend drugs and CAPA-NS. Retrieved from: www.kbn.ky.gov/ 

apply/arnpprescription 

Kentucky Coalition of Nurse Practitioners and Nurse Midwives (KCNPNM). (2011). 

Nurse practitioners and nurse midwives provide quality, cost effective care 

but barriers to their practice decrease patient access to care: A White paper. 

Kentucky Coalition of Nurse Practitioners and Nurse Midwives (KCNPNM). (2012). 

Reimbursement and credentialing information. Retrieved from: www.kcnpnm. 

org.?page=Reimbursement 

Kentucky Legislature (2006). Senate Bill 65. Frankfort, KY: Kentucky Legislature. 

Retrieved from www.lrc.govlrecord/06rs/SB65.htm 

Maylone, M. M., Ranieri, L., Quinn Griffin, M. T., McNulty, R., & Fitzpatrick, J. J. 

(2011). Collaborative and autonomy: Perceptions among nurse practitioners. 

American Academy of Nurse Practitioners, 23, 51-57. doi: 10.1111/j.1745- 

7599.2010.0053I.x 

Street, D., & Crossman, J. S. (2010). Does familiarity breed respect? Physician 

attitudes toward nurse practitioners in a medically underserved state. 

American Academy of Nurse Practitioners, 22, 431-439. doi: 10.1111/j.1745- 

7599.2010.0053I.x 

Vandenhouten, C. L., Malakar, C. L., Kubsch, S., Block, D. E., & Gallagher-Lepak, 

S. (2011). Political participation of registered nurses. Policy, Politics, & Nursing 

Practice, 12 (3), 159-167. doi: 10.1177/1527154411425189 

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KNA Centennial Video 

Lest We Forget Kentucky’s 

POW Nurses 

This 45-minute video documentary is a KNA 

Centennial Program Planning Committee 

project and was premiered and applauded 

at the KNA 2005 Convention. “During the 

celebration of 100 years of nursing in Kentucky— 

Not To Remember The Four Army Nurses From 

Kentucky Who Were Japanese prisoners for 33 

months in World War II, would be a tragedy. 

Their story is inspirational and it is hoped that it 

will be shown widespread in all districts and in 

schools throughout Kentucky. 

POW NURSES 

Earleen Allen Frances, Bardwell 

Mary Jo Oberst, Owensboro 

Sallie Phillips Durrett, Louisville 

Edith Shacklette, Cedarflat 

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Phone: (502) 637-2546 Fax: (502) 637-8236 

Email: Carleneg@Kentucky-Nurses.org 

It’s a new day. 

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We are inventing a new future for those 

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careers 

2009, 2010, 2011, 2012 & 2013 Distinguished Hospital Awards for Clinical Excellence. TM 

Humbled to be a 100 Top Hospitals ® Recipient 

District/Chapter 2 

News 

Membership meetings are fun, informative and 

provide a great opportunity for networking. Mark 

your calendar and join us at the Chop House on 

Richmond Road in Lexington on November 19th 

and February 18th at 5:30pm. Amy Herrington DNP, 

RN, CEN will be presenting “PreAdmission Nutrition 

Assessment of Geriatric Patients Undergoing Total 

Joint Revision” for one continuing education unit 

at the November meeting. Kerry Churchill RN, 

RYT Certified Yoga Nurse will present “YOGA & 

NURSING: STRESS RELIEF, BACK SAFETY & 

BEYOND” in February. 

Save the date: District/Chapter 2 Nurse 

Advocacy Conference June 19, 2014. Keynote 

speaker Rebecca M. Patton, MSN, RN, CNOR, 

FAAN Immediate Past President, American Nurses 

Association. 

District 2 Members attend KNA Summit. Left 

to right: Nancy Garth, Katherine Sallee, Laura 

Riddle, Kerry Churchill. 

Norton Healthcare 

Announces BSN To DNP 

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University Of Kentucky 

Norton Healthcare is pleased to announce that 

beginning January 1, 2014, its employees will be 

eligible to begin completion of BSN to DNP studies 

at the University of Kentucky College of Nursing. 

Those who apply for the program must have a BSN 

and three years of service at Norton Healthcare. 

The employees will be selected through a rigorous 

interview process. Once selected, they will need to 

work full time at a Norton Healthcare location while 

attending school full time. 

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PERSONAL EXPERIENCE 

Trackside Partnership Produces 

Multiple Winners 

During a check-up at the Kentucky Racing Health 

Services Center (KRHSC), one patient is diagnosed 

with an abscessed tooth and another patient 

receives an oral exam as part of a routine check-up. 

Under the leadership of University of Louisville 

assistant professor Dedra Hayden, APRN-BC, UofL 

nurse practitioner students and dental students 

and residents are working together to provide topquality 

health care to backside track workers who 

cannot afford care. This is part of a UofL effort that 

began in spring 2013 to engage students from the 

two professions in inter-professional education with 

the goal to improve the patient experience once these 

students become practitioners. And at the same 

time, expanding access to health care. 

“This program has provided me additional 

education in oral manifestations and pathology, 

and has enhanced my communication skills when 

collaborating with other disciplines – facilitating my 

development as a thorough provider for my future 

patients,” said nurse practitioner student Kelly Stice, 

BSN, RN, CCRN. 

“These interactions help us feel more comfortable 

interacting with other professions; it is helpful to 

learn how a nurse practitioner makes a diagnosis 

and treatment plan for a patient with diabetes, for 

example,” said general practice resident Lauren 

Parsons, DMD. 

Supported through a U.S. Department of Health 

& Human Services Health Resources and Services 

Administration grant, nursing and dental students 

are engaged in joint seminars, standardized patient 

learning and clinical experiences to better identify 

and manage systemic diseases such as diabetes and 

cardiovascular disease that are sometimes linked to 

oral health. 

Preliminary data show students in both 

professions have improved confidence in their ability 

to function as a member of an interdisciplinary 

team after going through the new learning model, a 

success that School of Nursing Director of Practice 

and International Affairs, Whitney Nash, PhD, 

APRN, presented at an Institute of Medicine (IOM) 

committee workshop, Assessing Health Professional 

Education. 

The IOM has said the impact of inter-professional 

education (IPE) could be measured by improvement 

in population health outcomes; better patient care; 

more inter-professional collaboration/understanding; 

and maximum value of services at lower costs. 

KNA Members 

On The Move 

Dr. M. Cynthia Logsdon, PhD, WHNP-BC, FAAN, 

RN presented the following at the 42nd Sigma Theta 

Tau International Biennial Conference: 

Logsdon, MC, Spalding, G, Stikes, R, 

Rothbauer, S, Doan, R Research Champions: 

An initiative to improve use of research 

evidence in nursing practice. 

Logsdon, MC, Eckert, D, Tomasulo, T, Hardin, 

C, Williams, C, Hogan, F, Myers, J. Use of 

research evidence by hospital based perinatal 

nurses to provide care for postpartum 

depression.

Welcome New Members 

The Kentucky Nurses Association welcomes the following new and/or reinstated members since the 

October/November/December 2013 issue of the Kentucky Nurse. 

District #1 

Jessica Alberico 

Mary Jane Ante 

Dawn Baik 

Sally S. Beckham 

Joanne Marie Berryman 

Leshia Blakey-Richardson 

Beverly Brangers 

Melissa Brown 

Carol Chase 

Paul F. Clay 

Lisa Marie Cook 

Dionyzia Dedina 

Pamela C. Derbin 

Kendall Diebold 

Lisa A. Dolan 

Margaret Dry 

Shoshana Dupree 

Vinzi Edward 

Erin Eichenberger 

Brian Eigelbach 

Jane Ellis 

Tina Ethington 

Ann Jeanette Glenn 

Jessica Goettl 

Linda Goss 

Leslie Michelle Gutman 

Brenda V. Hackett 

Mitsy Hardin 

Mary Ellen McClinton Hardy 

Kimberly Hatzman 

Tiffany Nicole Hubbard 

Gina Hueston 

Donna Iezzi 

Karen Janssen 

Jancy John 

Marian Jones 

Carla M. Judd 

Brenda Junk 

Alice Keeling 

Seema Kulkarmi 

Mary Katherine Kustes 

Lattis Lee 

Donna Long 

Suzanne Luzama 

Sonya Renee McCoy-Elam 

Janice S. McMahan 

Kathleen Miles 

Kari Moore 

Kimberly Morgan 

Priscilla Morgan 

Karen Lynne Morrow 

Loretta Napier 

Marquerite Newton 

Sheila Kaye Parsley 

Michelle Pike 

Sandra Pollock 

Kathryn Elizabeth Rickson 

Jody Rogers 

Marie Rowena Sale 

Susan E. Sherman 

Ashleigh Simpson 

Elizabeth Smith 

Gary Spalding 

Kimberly Spencer 

Stephanie Stout 

Stephanie Sturgeon 

Rachel Tanner 

Don Taylor 

Joetta Taylor 

Carly Townsend 

Elizabeth Triplett- 

Thieman 

Deborah Tuggle 

Sarah Turi 

Usha Varughese 

Eva Watson 

Margaret Wiedl 

Elizabeth Willibaum 

Davee Marie Wilson 

Andrew Wood 

Nancy York 

District #2 

Rebecca Alexander 

Francessa Banks 

Edna S. Barber 

Nancy Barnum 

Beth Bennett 

Heather Bradley 

Carolyn Lee Brophy-Huffman 

Amy Caucill 

Timothy Combs 

Jill Cornelson 

Sherri Couch 

Tammy Courtney 

Debbie Davenport 

Annette David 

Sherri Dotson 

Lisa Ecton 

Steven J. Fields 

Penny Gilbert 

Susan Melinda Greenlese 

Lisa Griggs 

Charlotte Hale 

Muna Hammash 

Natalie Hickam 

Tobi J. Holmes 

Gina Howard 

Amanda Jones 

Tricia Kellenbarger 

Eileen Kelty 

Elizabeth Louise Kijek 

Lawana Leonhardt 

Daniel Long 

Catherine Faughn Lowe 

Lisa Mick 

Elizabeth Northcutt 

Joan Osborne 

Julie Lynn Osborne 

Rebecca R. Ramsey 

Lisa Rauen 

Sara Reno 

Judith Riddle 

Kathryn Roberts 

Donna M. Roberts 

Vicki Rowe 

Elinor Smith 

Clemma Snider 

Elizabeth Spalding 

Frances M. Stone 

Andrea P. Vanorio 

Tonya Wilson 

District #3 

Beth Adams 

Gail Allen 

Patricia Atherton 

Alicia Clare 

Amy Cox 

Tina Crouch 

Lee Ann Ernst 

Pamela K. Fletcher 

Cindy Ginn 

Frances Gollahon 

Erin Gunsiorowski 

Edward Harris 

Kimberly Kendall 

Lillian Kincade 

June Kocsis 

Maria A. Layne 

Emily Rehkamp 

Benita Faye Ulz 

Cheryl Volpenhein 

Wilma E. Woodford 

Sarah Wright 

District #4 

Renee U. Baugus 

Rebecca L. Bell 

Beverly A. Bishop 

Lauren Capurro 

Tammy Jo Caudill 

Rebecca Deaton 

Michele Dickens 

Tabitha Drane 

Bonnie S. Embrey 

Stephanie Ferguson 

Dana Garrett 

Natalie Hickam 

Donna Holsapple 

Andrea Houser 

Siena W. Kennedy 

Cynthia Lemons 

Cathy Lewis 

Erin K. Martin 

Katherine Mattingly 

Sarah L. Mink 

Catherine Morris 

Martina Mouser 

Dionicia Russie 

Heather Marie Smith 

Georgia Wilson 

District #5 

Lynn Bushor 

Linda R. Cavitt 

Cheryl Lynn Ewing 

James Farley 

Kristen N. Fields 

Joshua Hilton 

Tonia Mailow 

Vanessa McGregor 

Heather Walker 

Sarah Wilson 

District #6 

Lisa Ann Bennett 

Sharon Braden 

Dawn Kilby 

William Edward Plotts 

Kristen Richerson 

Janie Carol Richie 

Kevin Scalf 

Blanche Schwinn 

Sharon Smith 

Tammy Walters 

District #7 

Stephanie Barefoot 

Teresa B. Bricker 

Paul Beachem 

Tonya M. Bragg- 

Underwood 

Vanessa A. Burd 

Debra Cain 

Debbie C. Cascaden 

Spencer Cole 

Carol Evans 

Judith Goodin 

Beverley Holland 

Tracy Jenkins 

Levita Larson 

Vanessa Littrell 

Wayne Robert MacGregor 

Anita Carol Meador 

Wendy B. Moore 

Jackie Lynn Parker 

Elaine B. Priest 

Rose Smith 

Mary Katherine Tucker 

Brandi L. Turner 

Judith Waddell 

District #8 

Debi S. Clark 

Cynthia Jo Emmick 

Debbie Enoch 

Shawna Hempfling 

Andrea M. Leach 

Brenda Lee 

Jacqueline Smith 

Janet Louise Thomason 

District #9 

Sheila Bentley 

Tammie J. Bertram 

Sherry K. Brown 

Delanna L. Clark 

Vicky Moore 

Carrie M. Myers 

Sandra M. Pelfrey 

Regina Rice 

Cynthia Savoie 

Eva Stone 

District #10 

Valerie Daniel 

Pamela Davis 

Carol Denny 

Robin Donahue 

Go to www.joinana.org to become a member 

and use the code: KNA2013 

Nathana Hall 

Kendra Howard 

Betty J. Karnes 

Teresa A. Lawson 

Marsha Lynn McKenzie 

Linda Kay Miller 

Carrie Lynette Murray 

Debra Parsons 

Sydney Purvis 

Jennifer Leigh Trent 

Sigrid Turner 

Lisa Wallace 

Mary Margaret B. Ward 

District #11 

Emily DeGraaff 

Christy Dehay 

Tamara A. Thibault Franks 

Susan Hightower 

Brenda Anne Stephens 

Marsha D. Woodall 

Laura Zink

“NURSING: LIGHT OF HOPE” 

by 

Scott Gilbertson 

Folio Studio, Louisville, Kentucky 

Photo submitted by the Kentucky Nurses Association, 

July 2005 to the Citizens Stamp Advisory Committee 

requesting that a first class stamp be issued honoring 

the nursing profession. (Request Pending) 

Package of 5 Note Cards with Envelopes - 5 for $6.50 

I would like to order “Nursing: Light of Hope” Note Cards 

______ Package of Note Cards @ 5 For $6.50 

______ Shipping and Handling (See Chart) 

______ Subtotal 

______ Kentucky Residents Add 6% Kentucky Sales Tax 

______ TOTAL 

Make check payable to and send order to: Kentucky Nurses Association, 

P.O. Box 2616, Louisville, KY 40201-2616 or fax order with credit card 

payment information to (502) 637-8236 or email to CarleneG@Kentucky- 

Nurses.org. For more information, please call (502) 637-2546. 

Name: _______________________________________ Phone: _____________________ 

Address: __________________________________________________________________ 

Credit Card: ___ Visa ___ MasterCard ___ Discover ___ American Express 

Number: ______________________________ Exp. Date: __________ CIV: _______ 

City: ________________________________ State: ______ Zip Code: _____________ 

Visa/Master Card/Discover/American Express: ___________________________ 

Expiration Date: __________________ CIV: _______________ 

Signature (Required for Credit Card Orders): __________________________________ 

Shipping and Handling 

$0.01 - $30.00…...$6.50 $60.01 - $200.00……$30.00 

$30.01 - $60.00…..$10.95 $200.01 and up…...…$45.00 

*Express Delivery will be charged at cost and will be charged to a credit 

card after the shipment is sent.

The 

Human 

Touch 

The Human Touch 

Her step is heavy 

Her spirit is high 

Her gait is slow 

Her breath is quick 

Her stature is small 

Her heart is big. 

She is an old woman 

At the end of her life 

She needs support and strength 

From another. 

 

Happy New Year from 

the Board & Staff of 

the Kentucky Nurses 

Association 

THE PAINTING 

“The Human Touch” is an original oil painting 

12” x 16” on canvas which was the titled 

painting of Marge’s first art exhibit honoring 

colleagues in nursing. Prompted by many 

requests from nurses and others, she published 

a limited edition of full color prints. These 

may be obtained from the Kentucky Nurses 

Association. 

Copyright 1980 

Limited Edition Prints 

by 

Marjorie Glaser Bindner 

RN Artist 

Limited Edition Full Color Print 

Overall size 14 x 18 

Signed and numbered (750)—SOLD OUT 

Signed Only (1,250)—$20.00 

Note Cards—5 per package for $6.50 

FOR MAIL OR FAX ORDERS 

The other woman offers her hand 

She supports her arm 

She walks at her pace 

She listens intently 

She looks at her face. 

She is a young woman at the 

Beginning of her life, 

But she is already an expert in caring. 

RN Poet 

Beckie Stewart* 

*I wrote this poem to describe the painting, 

The Human Touch by Marge.” 

Edmonds, Washington 1994 

________ Signed Prints @ $20.00 

________ Package of Note Cards @ 5 for $6.50 

________ Framed Signed Print @ $180.00 

_____Gold Frame 

_____Cherry Wood Frame 

I would like to order an art print of “The Human Touch”© 

Make check payable to and send order to: Kentucky Nurses Association, P.O. Box 2616, 

Louisville, KY 40201-2616 or fax order with credit card payment information to (502) 637-8236 

or email to carleneg@kentucky-nurses.org. 

_________ Total Purchases 

_________ Shipping & Handling (See Chart) 

_________ Subtotal 

_________ Kentucky Residents Add 6% Kentucky Sales Tax 

_________TOTAL 

Name: ________________________________________________________________________ Phone: _____________________ 

Address: ___________________________________________________________________________________________________ 

City: ______________________________________________________ State___________ Zip Code: ______________________ 

Tax Exempt Organizations Must List Exempt Number 

Shipping and Handling 

$ 0.01 to $ 30.00 . . . . . . . . . . . . . . . . . . . . . . . $6.50 

$ 30.01 to $ 60.00 . . . . . . . . . . . . . . . . . . . . . $10.95 

$ 60.01 to $200.00 . . . . . . . . . . . . . . . . . . . . $30.00 

http://ahec.med.uky.edu 

Vision 

Our vision is to be a premier academic and 

community-based collaborative educational 

program to improve the health of Kentuckians. 

Mission 

The mission of the Kentucky AHEC program 

is to promote health communities through 

innovative partnerships. This is accomplished 

by: 

 

professionals students and healthcare 

providers, 

 

 

professions as a career choice. 

Visa/MasterCard/American Express/Discover: __________________________________________________________________ 

Expiration Date: ___________________________________________ CIV: _________________________________________ 

Signature (Required): _______________________________________________________________________________________ 

$200.01 and up . . . . . . . . . . . . . . . . . . . . . . . $45.00 

*Express delivery will be charged at cost 

and will be charged to a credit card after the 

shipment is sent. 

Professional Nursing in 

Kentucky * Yesterday * 

Today Tomorrow 

KNA’s limited edition was published 

in 2006. Graphics by Folio Studio, 

Louisville and printing by Merrick 

Printing Company, Louisville. 

Gratitude is expressed to Donors 

whose names will appear in the 

book’s list of Contributors. Their 

gifts have enabled us to offer this 

limited edition hard-back coffeetable-type 

book at Below Publication 

Cost for Advance Purchase Orders. 

The Editors have collected pictures, 

documents, articles, and stories of 

nurses, nursing schools, hospitals, 

and health agencies to tell the story 

of Professional Nursing in Kentucky 

from 1906 to the present. 

Special Price - $18.87 Per Book 

______ $18.87 per book 

______ $1.13 sales tax per book 

______ Add $6.50 shipping and handling per book 

(for 1-5 books - $10 or 6-19 books $20) 

______ Total Purchase 

______ Grand Total 

Name _______________________________________________ 

Address _____________________________________________ 

City _____________________ State ____ Zip ____________ 

Credit Card Payment (Circle One): 

MasterCard – Visa – Discover - American Express 

Number _____________________________________________ 

Exp. Date _________________ CIV ____________________ 

Signature ___________________________________________ 

Fax, Mail or E-mail Order to: 


P.O. Box 2616, Louisville, KY 40201-2616 

FAX: 502-637-8236 

E-mail: carleneg@kentucky-nurses.org 

APRN 

Select Specialty Hospital, Lexington is actively recruiting 

Advanced Practice Registered Nurses 

with acute care experience. 

Being part of our dynamic clinical team will offer the 

opportunity to provide comprehensive compassionate care 

to the complicated medically complex patients. 

The ideal candidate will have current national certification 

from a board recognized national certification organization 

in addition to current APRN and RN licensure. 

CONTACT Shondell Thomas, Nurse Recruiter 

AT 877.582.2004 OR shothomas@selectmedical.com 

APPLY ONLINE at selectmedical.com/careers 

our hospitals are part of select medical’s network 

of more than 100 long-term acute care hospitals.

I’m inventing a new 

model of health care. 

Apply Today: 

VAcareers.va.gov/ALD 

Follow VA Careers 

Make it happen. 

It’s a balancing act you can do. 

RN-BSN | BSN-DNP | MSN-DNP | BSN-PhD | MSN-PhD 

Did you know that nearly a quarter of our students attend part time? You can work, have a family 

life and work toward your next nursing degree with our hybrid programs, designed for working nurses. 

Check out our website, www.uknursing.uky.edu. Contact our Student Services staff with questions. 

Let us show you how others have done it and you can, too! 

OUR DNP TRACKS INCLUDE: Adult-Gerontology Acute Care Nurse Practitioner | Adult-Gerontology Clinical Nurse 

Specialist | Pediatric Nurse Practitioner | Populations and Organizational Systems Leadership | Primary Care Nurse 

Practitioner (family or adult-gerontology) | Psychiatric/Mental Health Nurse Practitioner 

UK HealthCare recruiting 

CURRENTLY RECRUITING FOR: 

Staff Development Specialist/ED | Perioperative Director 

| Pediatric Congenital Heart Service Coordinator | 

Enterprise Emergency Services Director 

EXPERIENCED RNs IN THE FOLLOWING AREAS: 

Medical surgical | OR | Emergency Department | 

Endoscopy | Oncology/Bone Marrow Transplant 

For more information on employment at UKHC, including 

the possibility of advancing your education and qualifying 

for tuition reimbursement, visit our employment website 

at www.uky.edu/hr/ukjobs.

Kentucky Nurse - Jan. 2014

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