Nevada RNFORMATION

May, 2015 • Volume 24 • Number 2 www.nvnurses.org
Nevada RNFORMATION
THE OFFICIAL PUBLICATION OF THE NEVADA NURSES ASSOCIATION
The Nevada Nurses Association is a constituent member of the American Nurses Association
Quarterly publication direct mailed to approximately 33,000 Registered Nurses and Licensed Practical Nurses in Nevada
Nevada Action Coalition
Read the second article in a new column from the
Nevada Action Coalition, which is advancing the
Initiative on the Future of Nursing goals in Nevada.
Page 11
Rural and Frontier Nurses
New committee formed to focus on the needs of rural
and frontier nurses. Page 8
Focus on
Infectious Diseases
Happy
Nurses
Week
FDA MedWatch Program
Learn how to report a medical product or medication
side effect. Page 10
Creating Serendipity
Follow these 7 easy steps. Page 13
For more information, visit www.nvnurses.org
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to pounce when neglect, poverty, famine, or
war lets down the defenses.”
Hans Zinsser; Rats, Lice, and History (1934)

Page 2 • nevada RNformation May, June, July 2015
NNA Mission Statement
Editorial Board
The Nevada Nurses Association promotes professional nursing practice
through continuing education, community service, nursing leadership, and Editor: Wallace J. Henkelman, Ed.D, MSN, RN nvnursesassn@mvqn.net
legislative activities to advocate for improved health and high quality health
care for citizens of Nevada.
John Buehler Garcia, RN, BSN Denise Rowe, MSN, RN, FNP-C
Margaret Curley, BSN, RN
Kathy Ryan, MSN, RN-BC
NNA State Board of Directors
Mary Baker Mackenzie, MSN, RN Debra Toney, PhD, RN
John Malek, PhD, MSN, FNP-C Christy Apple Johnson, RN
Scott Lamprecht, DNP, MSN, RN, scott@cmcnevada.org ........ President Betty Razor, RN, BSN, CWOCN Elizabeth Brox, Student Member
Elizabeth Fildes, EdD, RN, CNE, CARN-AP, drfildes@aol.com .. Vice-President
Nicola Aaker, MSN, MPH, RN, CNOR, PHCNS-BC, naaker@aol.com ... Treasurer
Bernadette Longo, PhD, RN, CNL, APHN-BC ................. Secretary Are you interested in submitting an article for publication in
Heidi Johnston, MSN, RN, CNE, heidi.johnston@gbcnv.edu . . Director at Large RNFormation? Please send it in a Word document to us at
Mary Brann, DNP, MSN, RN, mary.brann@tun.touro.edu ... Director at Large nvnursesassn@mvqn.net. Our Editorial Board will review the article
Amy Pang, BSN RN, aepangster@gmail.com ............ Director at Large and notify you whether it has been accepted for publication.
Jean Lyon, PhD, RN, Jeanclyon@cs.com .............President, District 1 Articles for our next edition are due by March 1, 2015.
Donna Miller, RN donnagmiller@flyingicu.com ......... President, District 3
Teresa Serratt, PhD. RN, tserratt@unr.edu ....Northern Legislative Co-Chair
Katherine Cylke, DNP, RN, mcylke@cox.net ....Southern Legislative Co-Chair
If you wish to contact the author of an article published in
RNFormation, please email us and we will be happy to forward
your comments.
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May, June, July 2015 Nevada RNformation • Page 3
In this issue
6
focus
6 Antibiotics
5 Measles
8 New Antimicrobial Resistant
Pathogens
13
articles
12 Bullying in Nursing
13 Creating Serendipity in 7
Easy Steps
10 FDA MedWatch Program
13 Fifty Years in Nursing
11 Implementing Nurse Residency
Programs in Nevada
14 The Ethics of Caring
9 Vaccinations
regular features
12 Check it Out!
15 Membership Application
4 Message from President Scott
Lamprecht
14
“Perhaps when cultural assessment is combined with genetic assessment, this
could be the beginning of culturally holistic care.”
~ NNA President, Dr. Scott Lamprecht

Page 4 • nevada RNformation May, June, July 2015
president’s corner
Scott Lamprecht, DNP, RN, APN
President, Nevada Nurses Association
Hello Everyone!
It is hard to believe that Spring 2015 is already here! The 2015 Legislative
Session for Nevada is under way with Nurses Day at the Legislature last
month on February 25, 2015. The event was a tremendous success with
over 150 attendees. Thank you very much to Jean Lyon, APRN, District I
President, NNA Legislative Committee and Chair Carol Swanson, and the
many others who worked very hard to coordinate activities. It is vitally
important for nurses to be active in the legislative and policy processes that
affect life and healthcare in Nevada. How do we do this? Communication.
As a group and as individuals, nurses have a responsibility to speak up
and be heard in the legislature, our communities, work environments,
and professional organizations. It is also important to recognize this
communication needs to be open, honest, and reciprocal. Being or becoming
a member of NNA has great value in so many ways, but how many nurses
are aware of this and what values are important to nurses in Nevada? We
discussed “The Power of One” and active communication between NNA
to all nurses, professional
groups, facilities, and
individuals in Nevada is the
key. Please contact myself
or a NNA Board Member to
get involved in the process to
better life and healthcare for
all individuals in Nevada.
Best regards and
thank you for your active
participation!
If you would like to contact NNA or President Lamprecht, please
call 775-747-2333 or email nvnursesassn@mvqn.net.
Keeping Students Healthy,
Safe, and Ready to Learn!
(NASN 2015)
www.nevadaschoolnurses.com
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Celebrating National Nurses Week
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• Guiding teens towards building a
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• Supporting seniors through life transitions
• Guiding adults towards wellness
Because of our nurses and the extraordinary compassion and care they offer to our
patients, Montevista Hospital and Red Rock Behavioral Health Hospital have become
the largest and most comprehensive provider of behavioral health services for children,
adolescents, adults, and seniors within the southern Nevada region.
Montevista Hospital | Red Rock Behavioral Health Hospital
www.montevistahospital.com | peggy.tyson@strategicbh.com

May, June, July 2015 Nevada RNformation • Page 5
measles
Nicki Aaker, MSN, MPH, RN
Director, Carson City Health and
Human Services
Measles is a highly contagious virus that lives in
the nose and throat mucus of an infected person
and is transmitted by direct contact with infectious
droplets or by airborne spread when an infected
person breathes, coughs, or sneezes. The virus
can live for up to two hours on a surface or in
an airspace where the infected person coughed
or sneezed. Approximately 90% of unprotected
individuals exposed will become ill. The incubation
period usually is 10 – 14 days. The infectious period
is 4 days before and 4 days after the rash appears.
Measles typically starts with a fever, runny nose
(coryza), cough, red and watery eyes (conjunctivitis)
– (aka “the 3 C’s”), and a sore throat which lasts 2-3
days. Two or three days after symptom onset, tiny
white Koplik spots may appear inside the mouth.
A maculopapular rash usually appears 14-17 days
after exposure and lasts 5 – 7 days. Sometimes,
immunocompromised patients do not develop the
rash. The rash usually starts on the face or scalp,
then spreads to the neck/trunk, then arms and legs,
then disappears in the order of appearance. About
three out of 10 people who get measles will develop
one or more complications including pneumonia,
ear infections, diarrhea, brain swelling and death.
Individuals at high risk for complications include
infants and children under the age of 5 years, adults
over the age of 20 years, pregnant women, and
individuals with a compromised immune system.
Measles can be especially serious for children
younger than 5 years old.
Measles Vaccination
Measles can be prevented with the MMR
(measles, mumps, and rubella) vaccine and was
considered eliminated in the United States in 2000.
One dose of MMR vaccine is about 93% effective at
preventing measles if exposed to the virus, and two
doses are about 97% effective.
The Centers for Disease Control and Prevention
(CDC) recommends all children get two doses of
MMR vaccine, starting with the first dose at 12
through 15 months of age, and the second dose at
4 through 6 years of age. Children can receive the
second dose earlier as long as it is at least 28 days
after the first dose. Students at post-high school
educational institutions, travelers, and healthcare
personnel who do not have evidence of immunity
against the measles need two doses of MMR
vaccine, separated by at least 28 days. The CDC
assumes that all individuals born before 1957 have
been exposed to the measles and do not need to be
vaccinated. Adults born after 1957 who do not have
evidence of immunity against the measles should
get at least one dose of MMR vaccine.
Measles Diagnosis
Most US healthcare professionals have not
seen a case of measles. Measles should be a
differential diagnosis of febrile rash illnesses.
Testing for measles includes serology for IgM
within the first few days of rash onset, viral swab
of nasopharyngeal, oropharyngeal, or nasal
membranes for PCR. At this point, if positive, the
local health department should be notified. If the
patient has measles, a contract investigation will
need to be conducted. For more information, the
CDC conducted a conference call titled - Measles
2015: Situational Update, Clinical Guidance,
and Vaccination Recommendations. The slides,
transcript, audio and webcast can be accessed
at http://emergency.cdc.gov/coca/calls/2015/
callinfo_021915.asp.
References
Carson City Health and Human Services. (2015, February
9). Measles Fact Sheet. Retrieved from http://
gethealthycarsoncity.org/wp-content/uploads/2015/02/
MEASLES-Fact-Sheet-2_2015-3.pdf
Seward, J. (Presenter). (2015, February 19). Measles 2015:
Situational Update, Clinical Guidance, and Vaccination
Recommendations. Centers for Disease Control and
Prevention. Conference Call and Webinar. Retrieved
from http://emergency.cdc.gov/coca/calls/2015/
callinfo_021915.asp

Page 6 • nevada RNformation May, June, July 2015
antibiotics
A New Source of
Antibiotics?
Wallace J. Henkelman, EdD, MSN, RN
With all of the concern regarding the
rapid emergence of antibiotic resistant
bacteria, there is at least one bright spot
on the horizon. Not only is there a new
antibiotic being tested, but it was developed
using an entirely new technique which has
the potential of producing many more drugs.
Most existing antibiotics were developed
as a result of culturing soil bacteria in the
laboratory and testing their byproducts.
However, about 99% of soil bacteria cannot
be cultured, so their characteristics have not
been studied to this point. A group of European scientists have developed
a method, using specific growth factors, to study these organisms in situ.
As a result they have extracted a new antibiotic, Teixobactin, which inhibits
bacterial cell wall synthesis. The new drug has been shown to have excellent
activity against gram-positive pathogens including all drug-resistant strains
tested. Drug-resistant organisms tested included M. tuberculosis, Clostridium
difficile, Bacillus anthracis, and Staph. aureus. Serial passage through
several generations of bacteria did not demonstrate any mutations with drug
resistance to Teixobactin. Use of this new study technique has the promise
of producing a large number of additional new drugs.
Reference
Ling, L. L., Schneider, T., Peoples, A. J., Spoering, A. L., Engels, I., Conlon, B. P. … Lewis,
K. (2015, 22 January). A new antibiotic kills pathogens without detectable resistance.
Nature 517(7535). Retrieved from http://www.nature.com/nature/journal/v517/n7535/
full/nature14098.html
Antibiotic Resistance
Predictions
Wallace J. Henkelman, EdD, MSN, RN
In order to catch the attention of the general public and of politicians,
it is sometimes necessary to publicize worse-case scenarios. Hopefully,
recent publications from the United Kingdom are just worse-case
scenarios and not realistic predictions The U.K.’s Review on Antimicrobial
Resistance has stated that by 2050 the continued rise in antimicrobial
resistance could cause 10 million deaths per year and reduce Gross
Domestic Products by 2% - 3.5%.
Two scenarios were used to produce these predictions; RAND Europe
assumed that drug resistance would rise to 100% over 15 years with
the number of cases held constant; KPGM assumed that resistance
would rise by 40% with the number of infections doubled. Both looked
at six disease entities. They included three which already demonstrate
significant drug resistance (Klebsiella pneumonia, E. coli, and Staph.
Aureus) and three diseases which are a continuing concern for increasing
resistance (HIV, tuberculosis, and malaria). Malarial resistance leads to
the largest number of casualties while E.coli had the greatest economic
impact.
Reference
Zuraw, L. (2014, December 11). UK review makes staggering antibiotic
resistance predictions. Food Safety News. Retrieved from http://www.
foodsafetynews.com/2014/12/uk-review-releases-staggering-antibioticresistancepredictions/#VOt9o_nF-ZA
Overuse of Antibiotics
Dr. Scott W. Lamprecht, APRN, FNP-BC, RN
As nurses one of our many jobs is to educate patients. As an APRN, I
work with patients in my clinic everyday with a wide variety of illnesses
and conditions. Many of these are acute illnesses caused by viruses or
bacteria. For many years, patients would get sick with a wide variety
of “bugs” and get treated with antibiotics; many times these were viral
illnesses. We are now reaping the benefits of antibiotic overuse. Many
bacteria have become resistant to almost every antibiotic available. MRSA,
VRE, and Klebsiella are just a few examples. How does this happen? The
overuse of antibiotics is a major component. Antibiotics kill bacteria both
good and bad but have no effect on viruses. By killing “good” bacteria,
our bodies are at risk for opportunistic infections such as Candida albicans
(yeast) or Clostridium difficile. Some bacteria after frequent exposure
to antibiotics begin to change and become resistant. Patients tell me
“Amoxicillin does not work on me.” Perhaps this is because they have
taken it too many times for viral infections, or did not finish the full ten
days of dosing.
The key as a provider is knowing when to use antibiotics. I have
patients come to my clinic wanting antibiotics for a cold then get upset
when I explain what they have is viral and antibiotics are not indicated.
Patients have been conditioned to get a pill and feel better, rather than
let our immune system take care of the issue and just manage the
symptoms. Guidelines for using antibiotics include: temp greater than
101F, acute illness lasting greater than seven days, or exudate in the
pharynx. I frequently have patients come to my office with complaints
of congestion and cough for 24 hours or less. In these cases, a watchful
waiting approach can be very helpful but requires patients to be aware of
important signs/symptoms and when to notify the provider.
Another source of confusion is the color of nasal/respiratory secretions.
For many years it was thought that yellow or green secretions indicated
infection and required antibiotics. We now understand the color comes
from normal flora sloughing off due to inflammation in the respiratory
tract. Our body will generally kill a virus within three to four days, but
symptoms persist because of the residual inflammatory response.
Supportive care to manage symptoms is the key, not the use of antibiotics.
Antibiotics can save lives but can also cause other issues such as
opportunistic infections, drug-resistant organisms, and hepato-/renal
damage. Knowing when to use antibiotics is the key and educating
patients on antibiotic use is essential. Nurses play a pivotal role in
educating patients about their conditions and therapies, including the use
of antibiotics.

May, June, July 2015 Nevada RNformation • Page 7
The Overprescribing of Antibiotics: Can Habits be Changed?
Denise Rowe, MSN, RN, FNP-C
Antibiotics have been used since the 1940s
to treat infectious diseases and have been very
successful in reducing illness and death. Over the
years, antibiotics have become less effective as
many infectious organisms they are designed to
kill, have become more adaptable and resistant
to treatment. In the United States two million or
more people acquire infections that are resistant
to antibiotics and approximately 23,000 die yearly
from drug-resistant infections CDC February 22,
2015). The rise of food allergies, inflammatory
bowel disease and c-difficile have also been linked
to antibiotic overuse which destroys the normal
flora of the intestinal tract (Blaser, 2014).
There is consistent evidence that clinicians
overprescribe antibiotics and that patients
continue to request them in cases in which
they are unnecessary. Some insights into the
dynamic driving this behavior were provided
in the response from clinicians and patients to
a 2014 survey by Medscape called, Too Many
Antibiotics! Patients and Prescribers Speak Up
(Cox & Scuuder, 2015). Reasons clinicians gave for
prescribing antibiotics included a high certainty
that the antibiotics were needed (53%), an
uncertainty that an infection might be bacterial
(42%,), patient was sick and labs would take too
long (31%), patient refused or could not afford a
lab test (19%), malpractice fears (15%), and that
antibiotics would not harm and might help (10%).
Clinicians’ uncertainty and fear of being wrong
on diagnosis appear to be the main factor behind
inappropriate prescriptions (Spelling, Bartlett, &
Gilbert, 2015).
Patient responses were interesting and
controversial. Seventy-seven percent of patients
denied asking for or having an expectation of
getting antibiotics. Prescribers refute that statistic
as not credible by citing a common perception
that most patients expect to be given antibiotics.
Twenty-three percent of patients believed
antibiotics would not be harmful, therefore it was
justified to request antibiotics. Some believed
antibiotics would certainly cure an illness (85%);
others believed antibiotics always worked (25%).
Only 53% of patients said that the healthcare
provider discussed or provided information
on the dangers of antibiotic resistance from
inappropriately prescribed antibiotics.
How much influence patient demand for
antibiotics has had on clinician prescribing habits is
unclear. Clinicians commonly say patients regularly
demand antibiotics and are unhappy with any
other alternatives. Clinicians have also expressed
concerns about getting poor patient satisfaction
ratings after patients demand antibiotics and they
decline to issue prescriptions (Zgierski & Rabago,
2014). Instead of persistent adherence to clinical
evidence, patient satisfaction ratings appear to
be negatively influencing antibiotic prescribing
patterns. In one survey, 59% of prescribers
said their compensation was linked to patient
satisfaction scores; 20% said patient satisfaction
scores were a threat to their employment and,
50 % said the pressure to prescribe unnecessary
antibiotics resulted in inappropriate care. Clinicians
also said patient satisfaction got in the way of
good medical practice.
A big challenge for clinicians when deciding
whether or not to prescribe antibiotics is that
they do not have complete certainty about which
patients have viral versus bacterial infections.
Prescribers may want to play it safe by covering
themselves legally and psychologically. Likewise,
patients have a personal incentive to request
antibiotics they think might help them get better,
even if there is no significant scientific data to
support it.
Effective approaches to change prescribing
patterns could include,developing reasonably
priced, better rapid diagnostics tests to diagnose
and differentiate viral from bacterial infections
with certainty, clearer clinical guidelines for
diagnosing common viral illnesses like upper
respiratory infection and bronchitis, increased
access to antibiograms to educate prescribers,
malpractice reform to mitigate lawsuits, and giving
financial incentives such as pay-for-performance
when guidelines are followed. Consistent
adherence to guidelines among primary care and
specialty care clinicians is needed. Emergency
department and urgent care prescribers must be
especially vigilant in evidence-based prescribing
since patients frequently seek these venues
for antibiotics. We must re-evaluate how the
widespread utilization of patient satisfaction
surveys as a quality-of-care metric are negatively
impacting prescribing patterns and make
adjustments in how these metrics are weighted.
Clinicians need ongoing support and education
that antibiotic prescribing practices should not be
swayed by the perceived expectations of patients.
Further still, ongoing education of the general
public with more explicit and blunt messages on
the growing threat from antibiotics resistance
is needed at the national, state, and local
community level.
References
U.S. Centers for Disease Control. (2015). Antibiotic/
antimicrobial resistance. Retrieved from http://www.
cdc.gov/drugresistance/index.html
Blasér, M.J. (2014). Missing Microbes: How the Overuse of
Antibiotics Is Fueling Our Modern Plagues. New York:
Henry Holt and Co.
Yox, S., Scudder, L. (2014). Too many antibiotics! patients
and prescribers speak up. Retreived from http://www.
medscape.com/features/slideshow/public/antibioticmisuse
Spelling, B, Bartlett, J.G., Gilbert, D.N. (n.d.) How can
we turn the tide against inappropriate antibiotic
prescription? Retrieved from http://www.medscape.
com/viewarticle/828663
Zgierska, A., Rabago, D., Miller, M.M. (2014). Impact of
patient satisfaction ratings on physicians and clinical
care. Patient Preference and Adherence, 8: 437-446.
Happy National Nurses Week 2015!
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Page 8 • nevada RNformation May, June, July 2015
New Committee to Focus on
Rural and Frontier Nurses
Heidi Johnston MSN, RN, CNE
Great Basin College, Elko, NV
The Nevada Nurses Association has formed a new committee which will
focus on needs of rural and frontier nurses. We would like to encourage
nurses working in these areas to join us and help identify, create, and
provide resources to meet the needs of nurses within these communities.
Healthy People 2020 addresses access to healthcare with the goal of
improving access to comprehensive, quality, health care services. By offering
needed resources to nurses within these rural and frontier communities we
are helping to maintain a workforce that in turn meets the Healthy People
2020 goal. For more information or to join this committee please email Heidi
Johnston at heidi.johnston@gbcnv.edu.
New Kids in Town
New Antimicrobial Resistant Pathogens
Kathy Ryan, MSN, RN-BC, PHN
Poking your head outside your door can be risky business these days.
In the aisle at the supermarket you may pick up the freebie known as
community acquired pneumonia. In the isolation room at the hospital you
may pick up the costly MRSA (methicillin resistant staphylococcus aureus).
Of increasing concern, both nationally and internationally, is the ability of
pathogens to resist the medications designed to neutralize them.
There are several agencies monitoring disease incidence and prevalence,
and antimicrobial resistance; among them the Centers for Disease Control
and Prevention (CDC) and the World Health Organization. The CDC’s
Antibiotic Resistance Threat Report for 2013 lists their 18 greatest concerns
categorized according to level of concern.
Hazard Level Urgent pathogens (3) pose significant risks, are considered
“high-consequence,” and require public health attention to surveillance to
prevent transmission.
Hazard Level Serious pathogens (12) require continuing public health
monitoring and prevention activities.
Hazard Level Concerning pathogens (3) may cause serious illness and
may require rapid interventions.
The CDC’s website offers links to both the full report and the “Biggest
Threats” list. Public health education features include Protecting Yourself and
Your Family, Protecting Patients and Stopping Outbreaks, and Protecting the
Food Supply, with additional references and resources.
Please visit the CDC’s website at www.cdc.gov/drugresistance/index.html.

May, June, July 2015 Nevada RNformation • Page 9
vaccinations
The Role of Vaccination Requirements in School Children in the United States
Tracy Fellenstein, DNP, MBA, RN
Vaccination is one of the greatest successes in
public health history. In 1796 Dr. Edward Jenner
began the modern vaccine era by developing a
vaccine against smallpox, a disease which is now
considered eradicated (Riedel, 2005). In 2000 the
United States (U.S.) achieved measles elimination;
however, measles continues to be imported
into the U.S. (Centers for Disease Control and
Prevention [CDC], 2012). Poliomyelitis is also on
the verge of eradication, with the last indigenous
case in the U.S. occurring in 1979 (Malone and
Hinman, 2007).
Most vaccination-preventable diseases are
transmitted from person to person (Malone and
Hinman, 2007). Vaccination protects not only
the individual who receives the vaccination but
also the community. When a large proportion of
the community receives vaccination, generally
considered to be between 80% and 95%
depending on the disease, vaccinated individuals
serve as a barrier to transmission to others in the
community, protecting people who cannot receive
vaccination or who received vaccination but are
not protected due to vaccination failure. This
phenomenon is commonly referred to as “herdimmunity,”
or “community-immunity.”
School vaccination requirements have been
critical for vaccinating Americans for over a
century. Massachusetts became the first state
to require vaccination for school children in
1855 (Malone and Hinman, 2007). Almost half
of the states had a requirement for children to
be vaccinated by the beginning of the twentieth
century. All 50 states had laws covering students
first entering school, or preschool, by 1980.
Although all states have school vaccination
requirements, many states provide exemptions
for medical, religious, or philosophical reasons
(Cole & Swendiman, 2014). All 50 states allow
exemption from vaccination for medical reasons,
such as permanent or temporary conditions that
impair the child’s immune system (The College of
Physicians of Philadelphia, 2015). Two examples
are congenital disorders and medications like
chemotherapy. Other medical exemptions include
a documented allergy to a component of the
vaccine or if the child has had a previous serious
adverse event related to vaccination.
Currently 48 states allow exemption from
vaccination for religious reasons, including Nevada
(The College of Physicians of Philadelphia, 2015).
Twenty states allow personal belief exemptions
for parents and patients who have philosophical
objections to vaccination. Nevada does not allow
for personal belief exemptions. Nevada pupil
vaccination and exemption laws are covered under
Nevada Revised Statutes 392.435, 392.437, and
392.439, as well as others (National Conference of
State Legislatures, 2015).
After addressing safety and efficacy studies,
the Food and Drug Administration must license all
vaccines to be administered in the U.S. (Malone
and Hinman, 2007). In 1986 Congress approved
the National Childhood Vaccine Injury Act (NCVIA),
which established the National Vaccine Program
within the U.S. Department of Health and Human
Services (DHHS). The NCVIA allows the DHHS to
supervise all activities within the U.S. government
related to vaccine safety, research, development,
and monitoring.
The NVCIA also requires the CDC to develop
and update Vaccine Information Statements (VIS)
to advise patients and parents about the risks
and benefits of particular vaccines (CDC, 2014;
Malone and Hinman, 2007). Federal law mandates
that health care personnel provide a VIS to the
patient, parent, or legal representative before
administering certain vaccinations. Health care
personnel must also document the date the VIS
was provided and the edition of the VIS that was
provided.
The Advisory Committee on Immunization
Practices (ACIP), an advisory group to the CDC,
determines which vaccines to be administered
and the schedules for their use (Malone and
Hinman, 2007). ACIP, commonly in coordination
with the American Academy of Pediatrics and
the American Academy of Family Physicians,
issues recommendations for use of pediatric and
adult vaccines and a schedule for administration
of routine vaccines. These recommendations
are often used by states to determine which
vaccinations to require for school attendance. The
CDC and other public health organizations have
established vaccination registries to send parents
and patients reminders when vaccines are due to
help assure vaccinations are given according to
schedule.
Vaccinations are generally safe and effective
but have some risks. Vaccines have dramatically
decreased infectious diseases in the U.S. The role
of mandatory vaccination certainly helped achieve
this impact.
References available upon request.
Southwest Region
Indian Health Service
The Southwest Region Indian Health Service
is seeking Registered Nurses with Medical/
Surgical, ICU, Emergency, and OB/L&D
experience that have an innovative spirit
to improve the health status of our Native
American population. We support this effort by
providing:
• Loan Repayment Program –
Up to $20,000 annually.
• Innovative and cutting edge practices
• A proven health care team
• Exceptional Federal Benefits, including
Health and life insurance benefits
• Outstanding Federal Retirement
Plan, and much more
Our nursing career opportunities are based
on needs identified by our nursing executives
and patient population located at various
rural sites throughout the states of Arizona,
Nevada and Utah. The Southwest Region
also has the largest Medical Center in the
Indian Health Service located in downtown
Phoenix.
If you, or someone you know has an interest, please contact
CDR Stephen Navarro at 602-364-5222, or
email Stephen at Stephen.navarro@ihs.gov.
I hope we’ll talk soon.
P.S. Your Southwest adventure awaits you.
Registered Nurses
Adventure awaits in the Carson Valley - close to skiing, boating,
fishing or any other sport you like! You can even ride your bike
to work! Save money, less time commuting and spend more
time with your family! Working conditions, taxes and health
are better here in Douglas County than in any other county in
Northern Nevada. It’s greener on this side of Nevada - rugged,
relaxed, reachable! Come join the family. At Carson Valley
Medical Center Hospital we are seeking to expand our Nursing
staff. Located in Gardnerville Nevada, 20 miles from beautiful
South Lake Tahoe, CVMC is a full-service critical access hospital.
CVMC supports an ICU unit, med tele unit, outpatient infusion
center, ambulatory surgery center and 24 hour ER.
One Year recent critical care experience required. Successful
applicant will be scheduled a combination of shifts in the ICU
and Med-Surg/Telemetry department.
CVMC offers competitive wages and benefits, plus a retention
bonus of $5,000 over 2 years employment.
Interested applicants please apply online or fax
a resume to 775-783-3070 or
call 775-782-1506
Visit our website at
www.cvmchospital.org
Domestic Violence & Sexual Assault Training
“Informative, insightful and on occasion humorous”
19.25 CEU hours
The Nevada Board of Nursing has certified us as CEU
providers for Nevada nurses. We offer three and a half
day conferences on the topics of Domestic Violence
and Sexual Assault in Las Vegas and Reno.
Single day pricing is available.
Reno, May 5-8, 2015
Las Vegas, July 14-17, 2015
Las Vegas, September 15-18, 2015
To get your 19.25 CEU hours go to:
www.nevadaceus.com, or contact Rod Reder at
Rod@nicp.net or 813-294-9757.

Page 10 • nevada RNformation May, June, July 2015
FDA MedWatch Program
The FDA MedWatch Program and Nurses Like You
Cristina Klafehn, PharmD, BCPS, CDE, Health Programs Coordinator, FDA Office of Health and Constituent Affairs,
Office of External Affairs, Food and Drug Administration
Have you ever wondered if a side effect your
patient is experiencing is associated with a
medical product? Have you ever wondered how
the Food and Drug Administration (FDA) hears
about side effects of drugs and other medical
products once they are on the market? To put it
simply, we depend on you! FDA receives important
reports from the nation’s nurses, pharmacists,
doctors, and even consumers and patients
through the MedWatch program.
MedWatch, the FDA safety information and
adverse event reporting program was launched
over 20 years ago. Its purpose is to identify and
evaluate serious adverse events and product
quality issues related to the use of medical
products in the post-market setting. Often,
adverse events are undetectable in clinical trials
due to trial limitations such as short duration,
limited patient demographics, and confounding
Northern Nevada Adult
Mental Health Services
Registered Nurses–
Acute & Long Term Care
MGGH is located in the small friendly, affordable
community of Hawthorne and we are a well-staffed
rural Nevada Hospital and LTC Facility,
emphasizing quality care!
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Current NV license or ability to obtain one preferred.
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We are accepting applications for the following positions:
• Mid Level Medical Practitioner (APRN or PA)
• Psychiatric Nurse II (Full and Part Time) Dini-Townsend Hospital
Apply Online Today!
http://hr.nv.gov
medications and disease states. Even a handful of
MedWatch reports can trigger a safety signal that
may result in a change in how a product is labeled
and used.
The MedWatch program has two parts:
receiving safety information in, and
communicating safety information out. The first
part is a process that seeks and accepts the
voluntary reports of serious adverse events and
product quality problems into the FDA. Because
nurses are at the frontline of patient care, you are
ideally positioned to identify and report events
when they occur. There are also mandatory
reporting requirements for user facilities for
medical devices, and for manufacturers for other
regulated products such as medical devices,
biologics, and drugs.
Types of products to report
• Prescription and over-the-counter medications
• Nutrition products, including infant formulas,
dietary supplements, and herbal remedies
• Medical devices, from contact lenses and
breast implants to blood glucose meters and
pacemakers
• Biologics, such as human cells and tissues for
transplantation
• Cosmetics or make-up products
Examples of problems to report
A variety of events and problems can be
reported through the FDA MedWatch program
including serious adverse events, product quality
problems, near misses, medication and device use
errors, and therapeutic failures. Serious events
would be something that resulted in death, was
life-threatening, caused permanent disability,
required hospitalization, caused a birth defect,
or required some kind of help in order to prevent
permanent harm. However, events are not limited
to these categories. If you think that it an event is
serious, please report.
How to complete a report
You can submit a report in several ways:
• The form can be completed manually by
downloading and mailing by regular mail or
faxing into 1-800-FDA-0178
• A paperless report can be submitted online
• You can also call 1-800-FDA-1088 between
8:00 am and 4:30 pm EST to request a form
• Provide as many details in your report as
possible to improve the quality of report
(be specific about timing, lab values, dechallenge
and re-challenge information, etc.
• MedWatchLearn teaches students, health
professionals, and consumers how to
complete the forms necessary to report
problems to FDA. Here, you have the
opportunity to practice filling out FDA Form
3500 (for health professionals) or FDA Form
3500B (for consumers).
Evaluation of your report
Once a MedWatch report is submitted it is
captured in a database and analyzed. If, after
further evaluation, the FDA determines that the
product is associated with a risk, we may take
a variety of regulatory actions such as requiring
an update to a product label or packaging,
development of a RiskEvaluation and Mitigation
Strategy (REMS), or send out an FDA Drug Safety
Communication.
If a product risk is identified and a
regulatory course of action is decided, FDA
must communicate this information to health
professionals and the public. This brings us to the
second part of the MedWatch program, which
is FDA providing clinically important, productspecific
safety information. MedWatch gives health
professionals and patients access to relevant
safety information to share in their decisionmaking
about therapeutic and diagnostic choices.
The MedWatch web page, with over one
million visitors each month, is your gateway into
the FDA’s safety information for human medical
products, including drugs, biologic products,
medical devices, or dietary supplements. It is
a useful resource for the busy professional,
providing both individual product safety alerts and
a monthly compilation of safety labeling changes
for drugs and relevant biologic products.
Sign Up Today!
MedWatch offers several ways to help you
stay informed about the medical products you
prescribe, use, or dispense every day by sending
safety alerts directly to you. Sign up for free
MedWatch safety alerts by joining our MedWatch
E-list. You can also follow us in Twitter @
FDAMedWatch or by RSS feed.
www.nursingALD.com
Searching for
your dream job?
We can help.

May, June, July 2015 Nevada RNformation • Page 11
Implementing Nurse Residency Programs in Nevada
Susan Adamek PhD(c), RN, NEA-BC, FACHE, Nevada Action Coalition
In 2010 the Institute of Medicine (IOM)
published its most widely read report to date, The
Future of Nursing: Leading Change, Advancing
Health (Institute of Medicine [IOM], 2010). The
IOM recommended that nurse residency programs
be implemented for nurses who are new to the
profession, to advanced practice roles, and to new
roles within nursing. These structured programs
have been shown to enhance safety and quality
of care as well as reducing employee turnover.
However, there is widespread confusion about
definitions and terminology used to describe
residency programs. They vary in structure, in
length, and in content.
At a national level there are several major
initiatives in place. The National Council of State
Boards of Nursing, in collaboration with more than
35 nursing organizations from both urban and rural
areas, is considering a regulatory model. Results
of this study are expected to be released later this
year. The University Health System Consortium has
also collaborated with the American Association
of Colleges of Nursing (AACN) to develop a
comprehensive nurse residency program which is
one year in length and is designed to be adaptable
across a variety of settings. AACN has created
accreditation standards for residency programs.
The Nevada Action Coalition has identified the
recommendation to implement nurse residency
programs as one of its primary areas of focus.
A Transition into Practice committee has been
established using members from the Nevada
Hospital Association (NHA), the Nevada Alliance
for Nursing Excellence (NANE) and the Education
Subcommittee of the Health Care Sector Council.
This committee is gathering information about
the current state of nurse residency programs
in Nevada, with a goal of recommending a “best
practice” standard residency curriculum. Both
nursing and non-nursing champions have been
identified to lead this effort.
In Nevada, acute care hospitals have been
found to offer a wide range of programs for new
nurses. Some of the rural hospitals are only able to
offer two weeks with a preceptor before the new
graduate must assume a patient assignment. At
the other end of the spectrum, some facilities offer
structured on-boarding programs with didactic
content, precepted clinical experiences, simulation
lab practice, and support groups that last for
twelve months. The Nevada Action Coalition is
still gathering information about nurse residency
programs in our state, but it is already apparent
that some of our smaller hospitals could benefit
from additional resources to support their new
graduate nurses during their first year of practice.
Another initiative planned by the Nevada Action
Coalition is to ask the new graduates themselves
about their needs and experiences. This survey
will help us determine the efficacy of the current
transition into practice programs in the state, and
guide recommendations for best practices in the
future.
For the past several years the Nevada Hospital
Association Health Care Workforce Development
has offered financial assistance to hospitals that
hire newly licensed registered nurses. Through this
program, a percentage of the new nurse’s salary
for a designated period of time is reimbursed
to the hospital. Simulation lab experiences have
been funded. New nurses with financial need
may also qualify for assistance with some of
their individual expenses through this program,
including uniforms, medical equipment, books,
transportation, and child care. Although the funds
allocated to this program are limited, they have
allowed hospitals to afford bringing more new
nurses into the workforce.
Another creative approach to transitioning newly
licensed nurses into practice is being developed
by the University of Nevada, Las Vegas Continuing
Education Department. This non-hospital
sponsored nurse residency program is being
designed to assist new nurses who have been
unable to find jobs in nursing. The program will
include precepted clinical experiences, mentoring,
leadership coaching, online learning activities,
simulation experiences, technical skills practice,
and assistance with interviewing techniques and
resume development. Funding for this program will
be provided by Workforce Connections.
The Nevada Action Coalition welcomes
participation in our efforts to assure that effective
nurse residency programs are available to new
nurses in our state. If you are interested in
assisting our Transition into Practice Committee,
please contact Linda Paulic at (702) 522-7026 or
linda_paulic@nshe.nevada.edu.
References
Institute of Medicine. (2010). The future of nursing:
Leading change, advancing health. Washington D.C.:
The National Academics Press.

Page 12 • nevada RNformation May, June, July 2015
Check It Out!
Infectious diseases present continuing challenges for those working in
hospitals and national and international public health care settings. Although
science and technology advance health care at turbo speed, infectious
diseases persist as a leading cause of death.
The National Institute of Allergy and Infectious Diseases categorizes
infectious diseases as emerging, re-emerging, and persistent intractable.
• Emerging infectious diseases “include outbreaks of previously unknown
diseases or known diseases whose incidence in humans has significantly
increased in the past two decades.” Epidemiologists investigate the first
confusing constellation of signs and symptoms to define and describe
previously unknown diseases. But they are also attuned to the evolution
of known diseases resulting from changes in human interactions with
animals and the environment. This alteration in “transmission dynamics”
often increases both the ease and frequency of human exposure to
pathogens, and the incidence and prevalence of illness. For example,
the import of exotic animals as food sources and as pets links to recent
monkey pox and SARS outbreaks
• Re-emerging infectious diseases “are known diseases that have
reappeared after a significant decline in incidence.” Pathogenic survival
mechanisms such as adaptation and recombination present new strains
of old diseases that elude human immune systems and produce new
illness. Additional concerns include the inappropriate use and overuse
of medications and pesticides (producing pathogens and illness
resistant to chemical intervention), and an increasing noncompliance
with immunization guidelines (allowing the re-emergence of previously
controlled illness)
• Persistent intractable infectious diseases “have never been adequately
controlled on either the national or international level” (such as HIV/
AIDS, malaria, and tuberculosis). Given the ease of international travel,
illness common in the third world may now manifest in the first world
and be initially difficult to diagnose
A final consideration is the intentional use of pathogens in bioterrorism.
Widespread exposure to anthrax, smallpox, or other pathogens producing
mass casualties may severely impair U.S. health care systems’ response,
with catastrophic results.
The National Institute of Allergy and Infectious Diseases maintains a
commitment to education and research with a focus on HIV/AIDS, malaria,
and tuberculosis. Selected goals include understanding the relationships of
host, environment, and pathogen in predicting and preventing illness, and
developing diagnosis and treatment options (including vaccines).
Please visit the National Institute of Allergy and Infectious Diseases
website at www.niaid.nih.gov/topics/emerging/Pages/introduction.aspx.
The Infectious Diseases Society of America coordinates the Emerging
Infections Network of over 1100 infectious disease specialists to assist
public health entities with surveillance. Their website links include surveys,
projects, and resources.
Please visit the Emerging Infections Network website at http://ein.
idsociety.org.
The International Conference on Emerging Infectious Diseases serves
as a forum for public health professionals to share scientific information
on national and international infectious diseases. Discussion topics for the
August 2015 conference include:
• Antimicrobial resistance
• Bioterrorism and preparedness
• Foodborne, waterborne, vectorborne, and zoonotic diseases
• Global heath
• Nosocomial infections
Please visit the International Conference on Emerging Infectious Diseases
website at www.iceid.org.
Norton Sound Health Corporation
NSRH is a Joint Commission accredited facility with 18 acute care beds, 15 LTC
beds serving the people of the Seward Peninsula and Bering Straits Region of
Northwest Alaska. New hospital now open!
Contact
Rhonda Schneider, Human Resources
rmschneider@nshcorp.org
877-538-3142
‣ RNs
• ER • OB
www.nortonsoundhealth.org
Bullying in Nursing:
An Old Name for Horizontal
Lateral Violence
Is Lateral Violence intentional or is the impact of it not understood or
perceived by the instigator? Does the instigator of the lateral violence just
want to feel more empowered? Do managers attack the problem, or is it
swept under the carpet by saying “That’s just how she/he is.” Sometimes it
is a little of everything.
In the five hospitals in the Valley Health System, it was heard in every
class that someone was being yelled at in front of their patients and other
staff. This was being done not only by physicians, but by charge and staff
nurses as well. When nurses become discouraged and saddened by the
lack of compassion and remembrance by seasoned nurses of how it was
when they were new, it is easy to see how errors in the health system could
be made. When nurses can’t keep their mind on the task at hand, errors
happen.
In the Medical Surgical Internship program through VHS, something
has been done to correct the problem. At one time a growing problem, it
is one that has become less significant. When the program first started,
nurses came in and cried about how bad they felt and how they wanted
to give up on nursing because of the way someone in the profession had
made them feel. Some nurses threatened to walk off the job because they
didn’t deserve to be treated that way. As a nurse educator at the VHS, I
began to think back to the class put on by the Nevada Nurses Association
about lateral violence and things began to click. I came up with a bit of an
unorthodox way to present this to the nurses.
The first thing that is done is to place a tiara on my head and walk
around with a “magic” wand in my hand. I stop and say to a nurse “If you
could change anything at all on the floor on which you work, what would
it be?” I usually pick a male nurse first, because if he opens up, everyone
will. For the first several months it was always “For the nurses I work with
to treat me like a peer instead of yell at me in front of everyone.” Once
the discussion was started, it was evident that many nurses had the same
feeling. I then brought that nurse up and placed them in what I call the
“victim triangle” on the floor. In the triangle, I have three words on the
points; one is victim, another passive, the other anger. I begin yelling at that
person as if I am the person doing the bullying and ask them where they
would start on the triangle. The answer is always at victim. Once on the
victim spot we have a discussion with the class about how a victim feels.
Then I have them move to the passive point. With this, I tell them that now
they are thinking at a later time, that maybe this nurse just had a bad day,
or a child is sick, so maybe it is OK and will change. Then they go to the
other point which is anger. Here they talk about how they were made to feel
and that it isn’t OK to be treated like this which in turn makes them a victim
again. As the nurse bounces around in the triangle, I ask them how they are
going to get out. They look at me and say they aren’t sure. I tell them,
“Step out.”
Once the nurse steps out of the triangle, I have them sit and we start
discussing the acronym CUS. C=I’m concerned, U=I understand and S=Stop,
this is a safety issue. So I start filling in some verbiage for them to use
when lateral violence happens. I am concerned about how and where you
are presenting yourself at this time. I understand you are upset, but you
need to stop and we can go into another room to talk out of the hearing
range of everyone else, or maybe you would like to have this discussion in
front of the manager. Then we discuss using the chain of command in our
facility. If a nurse is the problem, go to the charge nurse, if the charge nurse
is the problem, go to the manager. If results are not made from this point,
continue higher.
Once the class is over and the evaluations are given, I read over and
over again how the nurses now feel more empowered to stand up to the
person who is doing the bullying. When I talked to some of the managers,
they were shocked to think their new nurses would not come to tell them
how they feel so things could be changed. Once this was relayed to the
managers, meetings were begun and the policies that were already in place
were discussed. An absolute “No tolerance for bullying’ was enacted and
things began to change.
This month was the time for Lateral Violence Class. I placed the tiara
on my head, brought out my magic wand and the questions began. To my
surprise, not one nurse in thirty-seven made one statement about being
bullied. It was all discussion on acuity of the patients, number of patients,
and the usual voicing of not having the equipment they need. Once that
discussion was made and some answers given, such as taking care of the
equipment that is provided, we went more in-depth about the growing
problem of lateral violence and how to stop it before it starts, even using
scenarios of physicians yelling and what to do about that.

May, June, July 2015 Nevada RNformation • Page 13
Fifty Years in Nursing
Linda Jacobson, MSN, RN, PHN, COI, Nevada State College
In 1962 I was a senior in high school. During
Christmas break I went for an interview at the
California Hospital School of Nursing (CHSN).
CHSN was a three-year Diploma nursing school.
Miss Barbara Jury interview me there. I thought
her as older, but my guess now is that she was
twenty-seven or twenty-eight years old. Oh, the
perspective of youth.
In August of 1962 I entered the School of
Nursing. We had orientation on Monday and
Tuesday mornings bright and early at 7 AM and
were placed on a nursing floor with “real” nurses
and patients. The first day we were all assigned a
patient with whom we were to talk; I remember
feeling very nervous and extremely apprehensive.
That started my 50 year journey in nursing, 53
years if I include nursing school.
The highlights of my nursing career were many.
An example was my first injection. We only had
glass syringes then that were reusable, as were
the needles. They were delivered every day from
Central Supply after being autoclaved. I also
remember at a later date when the first box of
disposable syringes arrived on the floor. That was
true progress.
Another career highlight was our Capping
Ceremony. We received our first stripe for our
caps. What a proud moment it was. We had
finished our probationary period and were on the
way to becoming nurses. A sad highlight occurred
in November of 1963 when it was announced
that President Kennedy had been shot. I was
assigned a patient that day who was suffering
from end-stage renal failure. The announcement
of President Kennedy’s death came over the PA
system as I was walking down the hall to my
patient’s room. With tears in my eyes I walked
into her room to find she had expired. That
was my first death and produced new feeling of
vulnerability to life events.
In our junior year we advanced to pediatric,
maternity, and psychiatric nursing. We spent three
months at the VA Hospital in Los Angeles, a very
different experience for an 18 year-old. Finally, in
our third year we accumulated three stripes on
our cap. And what a year it was since we were
then charge nurses, team leaders, and mentors to
freshmen and junior nursing students.
June 1965 finally came and we graduated in
a beautiful ceremony and got our “black” stripe
for our caps. It was then time to study for State
Boards. In July 1965 we traveled to Long Beach,
California and took tests in med-surgical, pediatric,
maternity, and psychiatric nursing. Testing took
two and half days. (I should mention that I had a
nasty case of chicken pox at the time which made
taking State Boards a true challenge). Then it was
a waiting game; results took about six weeks and
came in the mail. State Boards were only given
twice a year, in July and January, so if one did not
pass, they had to wait six months to take State
Boards again.
In September I finally received my letter and
was afraid to open it, but to my relief I had
passed. In was then off on a job hunt. My first
job was for a hospital in Burbank, California
working the 3-11 PM shift in the float pool. We
had no orientation to the hospital. My first evening
I was assigned to a medical-surgical floor as the
treatment nurse working with what I thought
was an extremely seasoned nurse, but who
was less than helpful. But I was prepared, I had
the training, and knew I could do the job. That
position was my start in the nursing profession.
Over the next five decades I worked in medicalsurgical
units, coronary care and intensive care
units, emergency rooms, hemodialysis units,
home health, and hospice. I also served as Staff
Educator and Director of Nursing. Along the way
I had two children and went back to school for
Bachelors and Masters Degrees in nursing.
Ten years ago I accepted a position at Nevada
State College as a new faculty member in a new
school. I knew I liked to teach but this has turned
out to be far more rewarding than I thought
possible. I love teaching the students and being
part of their success. I teach in the RN to BSN
Program, and this has been very rewarding. Being
an alumni of an RN to BSN program myself, I have
a great appreciation for what these students go
through.
As I look back over the last 50 years and the
changes in nursing, the advances in diagnostic
testing, technology, computerized charting,
the diversity in nurses, as well as in the patient
population, I am proud to be a part of such a
rewarding, satisfying, and worthwhile profession
as nursing.
Creating Serendipity in 7 Easy Steps
Alberto Hazan, MD
The story went something like this:
On an ordinary September morning in 1928,
Alexander Fleming, a Scottish bacteriologist
working at St. Mary’s Hospital in London, came
back from vacation to find that one of his Petri
dishes containing Staphylococcus aureus growing
in culture had been contaminated by greenish
mold.
Instead of throwing a fit, Fleming grew curious
over this finding. After much thought and months
of further testing, he discovered that there was
something in the fungus that had killed off the
bacteria, and he isolated this mysterious fluid. He
would later call this substance penicillin. 1
This serendipitous event sparked a revolution
in medicine. Because of this single discovery,
millions of people’s lives have been saved. Limbs
have been spared amputation; common infections
eradicated.
But an important event that preceded this
discovery is often left untold. Six years earlier,
Fleming was working on a similar Petri dish filled
with bacteria. He happened to have an upper
respiratory infection at the time, and some mucus
from his nose leaked out and dropped onto the
dish.
To Fleming’s astonishment, the bacteria
disappeared. Thus, the discovery of lysozyme,
an enzyme found in bodily fluids used to kill off
bacteria.
It was this initial discovery that primed Fleming
to search for a substance that he believed could
fight off infection without being detrimental to the
human body. When he noticed that contaminated
Petri dish, his mind instantly recognized the
potential of this random finding. 2
Can serendipity be engineered?
We’ve all been taught that serendipity is
capricious, striking at her own whim in seemingly
inopportune times. After all, serendipity is
technically defined as “the occurrence of an
event by chance that leads to a beneficial result.”
The term itself comes from a Persian fairy
tale, The Three Princes of Serendip, where the
main characters are constantly making major
discoveries by accident during their travels. 3
Science, of course, is replete with examples
of people making fortuitous, albeit unintentional,
breakthroughs. Take Isaac Newton and the
discovery of gravity. What if Newton hadn’t taken
a walk under that tree and been hit in the head by
the proverbial apple?
What about the discovery of the microwave?
This was attributed to Percy Spencer in the
1940s when he noticed that the chocolate bar
in his pocket had melted after he stood near a
magnetron, a vacuum tube emitting microwaves
and used for radar. 4
And the Big Bang theory? At first, the annoying
static heard by astronomers Arno Penzias and
Robert Wilson while working at Bell Labs in New
Jersey was attributed to pigeons living in a nearby
antenna. But after the pigeons were shot and
the noise persisted, the pair recognized the noise
likely originated from background cosmic radiation
from the Big Bang. 5
And yet, there are common threads in these
and the thousands of other discoveries attributed
to serendipity. On the surface it appears like each
of these breakthroughs relied on chance—being at
the right place at the right time—but a closer look
at the people behind these discoveries reveals
that chance had very little to do with anything.
Indeed, these scientists actually share several
characteristics. These commonalities reveal that
Creating Serendipity continued on page 15

Page 14 • nevada RNformation May, June, July 2015
The Ethics of Caring
John Malek, PhD, MSN, APRN
While there are many key concepts within
the framework of nursing, caring is a central
construct within the discipline of our profession.
As such, we should be concerned about the
ethical implications of caring, its application and
effect on our practice. Discussion on the theory
of ethics of care has been well documented
since the early 1980’s beginning with the work
of Dr. Jean Watson. Among the early conceptual
frameworks in nursing, Dr. Watson’s Theory of
Caring is described as a moral ideal that involves
mind, body, and soul engagement with another.
Most of us consider caring to be something of a
moral obligation to our patients from which action
emanates. The ethics of care considers three
distinct elements that not only involve actions,
but also a focus on relationships between power
and caring practices as well as addressing the
question, “What is the best way to care for this
patient at this time?” Tronto (1993) postulates
four elements of caring that include attentiveness,
responsibility, competence, and responsiveness
of the care receiver. Focusing on each element
individually and collectively we can understand
how caring is ethically responsible.
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Caring is a feeling that also requires an
action. According to Lachman (2009), “caring
lies on a continuum, with different levels of
emotional involvement for individuals in a caring
relationship.” An illustrative example would be
caring for your pet versus caring for an ailing
relative. So the question is, “How can we meet the
responsibility of caring?” There are four distinct
phases within the ethics of caring model: (1)
caring about, (2) taking care of, (3) care giving,
and (4) care receiving.
• Caring about implies recognizing a
need. An example would be identifying/
relating to what a patient needs at this
particular time such as chills, fever,
nausea, vomiting, pain, emotional
distress, and includes obtaining a
thorough history.
• Taking care of implies a responsibility
to take action. Responsibilities
include providing reassurance and
explanations, ordering diagnostic tests,
starting IVs, preparing medication to
be administered. In addition, these
responsibilities include conducting a
physical exam.
• Examples of care giving include
administering medications(s), providing
warmth, keeping patients and families
informed, and providing education.
Taking action implies suggesting or
implementing a change.
• In care receiving we assess the success
of a particular intervention.
Collectively, these strategies involve an
interrelationship between cognition, emotion, and
actions. For many of us this may represent the
essence of the nursing process. However, for the
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patient to actually experience the ethics of caring,
this can only be achieved by the implementation
of the stated strategies listed.
Effective care is based upon our knowledge,
skills, abilities, and attitudes. As you can see, a
lack of any of these elements raises ethical issues
that correlate directly to competency. Failing to
acknowledge a lack of competency in a given
situation could result in action against a nurse’s
license, malpractice acrtions, and detrimental
outcomes for patients and families. According to
the ANA (2001), “Continual professional growth,
particularly in knowledge and skill, requires a
commitment to lifelong learning.”
Most nurses have been exposed to Watson’s
caring theory, but many of us are not aware of the
ethics of care. Dr. Watson’s caring theory contains
three major elements: (1) the carative factors,
(2) the transpersonal caring relationship, and (3)
the caring occasion/caring moment. As we honor
nursing’s work to care for patients, let us also
remember that caring without action is essentially
meaningless from an ethical perspective.
References
Allmark, P. Can there be an ethics of care? Retrieved from
Journal of medical ethics 1995; 21: 19-24. http://jme.
bmj.com/ Doi: 10.1136/jme.21.1.19
American Nurses Association (ANA). (2008). Guide to the
code of ethics for nurses: interpretation and application.
Silver Spring, MD: Author.
Lachman, V.D. (2009). Ethical challenges in healthcare:
Developing your moral compass. New York, NY:
Springer.
Tronto, J. (1993). Moral boundaries: A political argument
for an ethic of care. New York, NY: Routledge
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May, June, July 2015 Nevada RNformation • Page 15
Creating Serendipity continued from page 13
there are things we can all do to have serendipity’s
fickle limbs embrace our work and increase our
likelihood for making great discoveries.
1. Be curious. Never stop asking questions.
Always try to come up with connections.
Ponder the “what ifs.” Dig deeper into the
task at hand to find the core of the problem.
Keep studying, learning, listening.
2. Be alert. Live in the moment. Try to be
engaged. Pay close attention to what you’re
doing. Focus.
3. Be open-minded. Don’t discount anything too
early. Embrace flexibility. Think outside the
box.
4. Be inclusive. Work in collaboration. Support
your colleagues, and share your ideas freely.
5. Be tenacious. Do not fear failure or getting
Semmelweised 6 (i.e. being ridiculed by your
colleagues). The easy road is often the wrong
one to take.
6. Be responsible. Work hard but don’t forget to
take care of your basic needs.
7. Be wary of the status quo. If you’re not
challenging the way things are by constantly
asking yourself how things can be made
faster, cheaper, easier, or better, then
you won’t be mentally prepared when the
opportunity strikes.
Alexander Fleming never expected that mold
found in stale bread could have anti-bacterial
properties, but because he was already engaged
in the pursuit of finding a substance that could
kill off Staphylococcus in culture—and because
he was curious, tenacious, and disciplined—he
immediately recognized the significance of finding
the halos of growth inhibition in the contaminated
media.
As Louis Pasteur, the scientist originally credited
with confirming that bacteria causes disease, best
put it: “Chance only favors the prepared mind.” 7
Reference available upon request.
—Alberto Hazan is an emergency physician
in Las Vegas and an assistant attending at St.
Luke’s-Roosevelt/Mt. Sinai in New York City. He is
the author of the medical thriller Dr. Vigilante and
the preteen urban fantasy series The League of
Freaks.
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Page 16 • nevada RNformation May, June, July 2015
UNIVERSITY OF NEVADA, RENO
Orvis School of Nursing
www.unr.edu/nursing
• B.S. in Nursing
• RN to BSN
• M.S. in Nursing
o Clinical Nurse Leader
o Nurse Educator
o Adult Gerontology Acute Care Nurse Practitioner
o Family Nurse Practitioner
o Psychiatric Mental Health Nurse Practitioner
(Opening Fall 2015)
• DNP (Doctor of Nursing Practice)*
University of Nevada, Reno
Statewide • Worldwide
*The DNP program is a collaborative program with UNLV. Students admitted through UNR for this program have their DNP degree conferred by UNR.